3,5-diamino-6-chloro-N-(n-(4-phenylbutyl)carbamimidoyl)pyrazine-2-carboxamide compounds

ABSTRACT

The present invention relates compounds of the formula: 
                         
or pharmaceutically acceptable salts thereof, useful as sodium channel blockers, as well as compositions containing the same, processes for the preparation of the same, and therapeutic methods of use therefore in promoting hydration of mucosal surfaces and the treatment of diseases including cystic fibrosis, chronic obstructive pulmonary disease, asthma, bronchiectasis, acute and chronic bronchitis, emphysema, and pneumonia.

CONTINUING APPLICATION INFORMATION

This application is a Continuation of application Ser. No. 14/106,098,filed on Dec. 13, 2013, allowed, which claims benefit to ProvisionalApplication No. 61/738,235, filed on Dec. 17, 2012, both of which areincorporated herein by reference.

FIELD OF THE INVENTION

The present invention relates to novel substituted3,5-diamino-6-chloro-N—(N-(4-arylbutyl)carbamimidoyl)pyrazine-2-carboxamidecompounds, particularly including substituted3,5-diamino-6-chloro-N—(N-(4-phenylbutyl)carbamimidoyl)pyrazine-2-carboxamidecompounds, such as3,5-diamino-N—(N-(4-(4-((S)-4-amino-3-(3-(bis((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)phenyl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamideand its enantiomers and pharmaceutically acceptable salts, useful assodium channel blockers, compositions containing the same, therapeuticmethods and uses for the same and processes for preparing the same.

BACKGROUND OF THE INVENTION

The mucosal surfaces at the interface between the environment and thebody have evolved a number of “innate defenses”, i.e., protectivemechanisms. A principal form of such innate defense is to cleanse thesesurfaces with liquid. Typically, the quantity of the liquid layer on amucosal surface reflects the balance between epithelial liquidsecretion, often reflecting anion (Cl⁻ and/or HCO₃ ⁻) secretion coupledwith water (and a cation counter-ion), and epithelial liquid absorption,often reflecting Na⁺ absorption, coupled with water and counter anion(Cl⁻ and/or HCO₃ ⁻). Many diseases of mucosal surfaces are caused by toolittle protective liquid on those mucosal surfaces created by animbalance between secretion (too little) and absorption (relatively toomuch). The defective salt transport processes that characterize thesemucosal dysfunctions reside in the epithelial layer of the mucosalsurface.

One approach to replenish the protective liquid layer on mucosalsurfaces is to “re-balance” the system by blocking Na⁺ channels andliquid absorption. The epithelial protein that mediates therate-limiting step of Na⁺ and liquid absorption is the epithelial Na⁺channel (“ENaC”). ENaC is positioned on the apical surface of theepithelium, i.e. the mucosal surface-environmental interface. Ideally,to inhibit ENaC mediated Na⁺ and liquid absorption, an ENaC blocker ofthe amiloride class will be delivered to the mucosal surface andmaintained at this site to achieve maximum therapeutic benefit.

The use of ENaC blockers has been reported for a variety of diseaseswhich are ameliorated by increased mucosal hydration. In particular, theuse of ENaC blockers in the treatment of respiratory diseases such ascystic fibrosis (CF), and COPD, including chronic bronchitis (CB) andemphysema, which reflect the body's failure to clear mucus normally fromthe lungs and ultimately result in chronic airway infection has beenreported. See, Evidence for airway surface dehydration as the initiatingevent in CF airway disease, R. C. Boucher, Journal of Internal Medicine,Vol. 261, Issue 1, January 2007, pages 5-16; and Cystic fibrosis: adisease of vulnerability to airway surface dehydration, R. C. Boucher,Trends in Molecular Medicine, Vol. 13, Issue 6, June 2007, pages231-240.

Data indicate that the initiating problem in both CB and CF is thefailure to clear mucus from airway surfaces. The failure to clear mucusreflects an imbalance in the quantities of mucus as airway surfaceliquid (ASL) on airway surfaces. This imbalance results in a relativereduction in ASL which leads to mucus concentration, reduction in thelubricant activity of the periciliary liquid (PCL), mucus adherence tothe airway surface, and failure to clear mucus via ciliary activity tothe mouth. The reduction in mucus clearance leads to chronic bacterialcolonization of mucus adherent to airway surfaces. The chronic retentionof bacteria, inability of local antimicrobial substances to killmucus-entrapped bacteria on a chronic basis, and the consequent chronicinflammatory response to this type of surface infection, are manifest inCB and CF.

There is currently a large, unmet medical need for products thatspecifically treat the variety of diseases which are ameliorated byincreased mucosal hydration, including CB, COPD and CF, among others.The current therapies for CB, COPD and CF focus on treating the symptomsand/or the late effects of these diseases. However, none of thesetherapies effectively treat the fundamental problem of the failure toclear mucus from the lung.

R. C. Boucher, in U.S. Pat. No. 6,264,975, describes the use ofpyrazinoylguanidine sodium channel blockers for hydrating mucosalsurfaces typified by the well-known diuretics amiloride, benzamil, andphenamil. However, these compounds are relatively impotent, consideringthe limited mass of drug that can be inhaled to the lung; (2) rapidlyabsorbed, and thereby exhibiting undesirably short half-life on themucosal surface; and (3) are freely dissociable from ENaC. More potentdrugs with longer half-lives on the mucosal surface are needed.

Too little protective surface liquid on other mucosal surfaces is acommon pathophysiology of a number of diseases. For example, inxerostomia (dry mouth) the oral cavity is depleted of liquid due to afailure of the parotid sublingual and submandibular glands to secreteliquid despite continued Na⁺ (ENaC) transport mediated liquid absorptionfrom the oral cavity. Keratoconjunctivitis sira (dry eye) is caused byfailure of lacrimal glands to secrete liquid in the face of continuedNa⁺ dependent liquid absorption on conjunctional surfaces. Inrhinosinusitis, there is an imbalance between mucin secretion andrelative ASL depletion. Failure to secrete Cl— (and liquid) in theproximal small intestine, combined with increased Na⁺ (and liquid)absorption in the terminal ileum leads to the distal intestinalobstruction syndrome (DIOS). In older patients excessive Na⁺ (andvolume) absorption in the descending colon produces constipation anddiverticulitis.

The published literature includes a number of patent applications andgranted patents directed toward pyrazinoylguanidine analogs as sodiumchannel blockers. Examples of such publications include PCT PublicationNos. WO2003/070182, WO2003/070184, WO2004/073629, WO2005/025496,WO2005/016879, WO2005/018644, WO2006/022935, WO2006/023573,WO2006/023617, WO2007/018640, WO2007/146869, WO2008/031028,WO2008/031048, and U.S. Pat. Nos. 6,858,614, 6,858,615, 6,903,105,6,995,160, 7,026,325, 7,030,117, 7,064,129, 7,186,833, 7,189,719,7,192,958, 7,192,959, 7,192,960, 7,241,766, 7,247,636, 7,247,637,7,317,013, 7,332,496, 7,345,044, 7,368,447, 7,368,450, 7,368,451,7,375,107, 7,388,013, 7,399,766, 7,410,968, 7,745,442, 7,807,834,7,820,678, 7,842,697, 7,868,010, 7,875,619, 7,956,059, 7,981,898,8,008,494, 8,022,210, 8,058,278, 8,124,607, 8,143,256, 8,163,758,8,198,286, and 8,211,895.

There remains a need for novel sodium channel blocking compounds withenhanced potency and effectiveness on mucosal tissues. There alsoremains the need for novel sodium channel blocking compounds thatprovide therapeutic effect, but minimize or eliminate the onset orprogression of hyperkalemia in recipients.

SUMMARY OF THE INVENTION

This invention provides compounds of Formula (A):

wherein Ar is a moiety selected from the group of:

X is selected from —CH₂—, —O—, or —S—;

R¹ and R² are independently selected from H and C₁-C₆ alkyl;

or R¹ and R² together with the nitrogen atom to which they are boundform a 5-membered or 6-membered heterocyclic ring optionally containingone additional ring heteroatom selected from N or O;

R³ is an alkyl group having from 3 to 8 carbon atoms or apolyhydroxylated alkyl group having from 3 to 8 carbon atoms;

R⁴ is a polyhydroxylated alkyl group having from 3 to 8 carbon atoms;and

R⁵ is selected from H or C₁-C₃ alkyl;

or a pharmaceutically acceptable salt thereof.

The invention also provides solvates and hydrates, individualstereoisomers, including optical isomers (enantiomers and diastereomers)and geometric isomers (cis-/trans-isomerism), mixtures of stereoisomers,and tautomers of3,5-diamino-N—(N-(4-(4-((S)-4-amino-3-(3-(bis((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)phenyl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide, or apharmaceutically acceptable salt thereof, as well as pharmaceuticalcompositions comprising the compound, or a pharmaceutically acceptablesalt thereof, its use in methods of treatment, and methods for itspreparation.

BRIEF DESCRIPTION OF THE DRAWINGS

A more complete appreciation of the invention and many of the advantagesthereof may be readily obtained by reference to the information hereinin conjunction with the following figures:

FIG. 1 is a graph demonstrating a 4-hour dose response of Compound II-dcompared to vehicle.

FIG. 2 is a graph of the effect od Compound II-d on sheep plasma.

FIG. 3 is a graph demonstrating the effect of Compound II-d on Sheep MCC4 hours post-dose.

FIG. 4 is a graph demonstrating the effect of Comparative Example 1 onSheep MCC 4 hours post-dose.

FIG. 5 is a graph demonstrating the effect of Comparative Example 1 onplasma potassium in sheep.

FIG. 6 is a graph demonstrating the effect of Compound II-d andComparative Example 1 on Sheep MCC 4 hours post-dose.

FIG. 7. is a graph demonstrating the effect of Compound II-d andComparative Example 1 on plasma potassium in sheep.

DETAILED DESCRIPTION OF THE INVENTION

Also provided are embodiments comprising twelve groups of compoundsindependently represented by Formulas (B), (C), (D), (E), (F), (G), (H),(I), (J), (K), (L), and (M):

wherein, in each group (B), (C), (D), (E), (F), (G), (H), (I), (J), (K),(L), and (M):

R¹ and R² are independently selected from H and C₁-C₆ alkyl;

or R¹ and R² together with the nitrogen atom to which they are boundform a 5-membered or 6-membered heterocyclic ring optionally containingone additional ring heteroatom selected from N or O; R³ is an alkylgroup having from 3 to 8 carbon atoms or a polyhydroxylated alkyl grouphaving from 3 to 8 carbon atoms;

R⁴ is a polyhydroxylated alkyl group having from 3 to 8 carbon atoms;and

R⁵ is selected from H or C₁-C₃ alkyl;

or a pharmaceutically acceptable salt thereof.

Within each group of compounds represented by Formulas (A), (B), (C),(D), (E), (F), (G), (H), (I), (J), (K), (L), and (M) there is a furthergroup of compounds wherein:

R¹ and R² are independently selected from H and C₁-C₆ alkyl;

R³ and R⁴ are each, independently, a polyhydroxylated alkyl group havingfrom 3 to 8 carbon atoms;

R⁵ is selected from H or C₁-C₃ alkyl;

or a pharmaceutically acceptable salt thereof.

Within each group of compounds represented by Formulas (A), (B), (C),(D), (E), (F), (G), (H), (I), (J), (K), (L), and (M) there is a furthergroup of compounds wherein:

R¹ and R² are independently selected from H and C₁-C₃ alkyl;

R³ is an alkyl group having from 3 to 8 carbon atoms; and

R⁴ is a polyhydroxylated alkyl group having from 3 to 8 carbon atoms;

R⁵ is selected from H or C₁-C₃ alkyl;

or a pharmaceutically acceptable salt thereof.

Also within each group of compounds represented by Formulas (A), (B),(C), (D), (E), (F), (G), (H), (I), (J), (K), (L), and (M) there is afurther group of compounds wherein:

R¹ and R² are, independently, selected from H and —CH₃;

R³ is an alkyl group having from 3 to 8 carbon atoms or apolyhydroxylated alkyl group having from 3 to 8 carbon atoms;

R⁴ is a polyhydroxylated alkyl group having from 3 to 8 carbon atoms;and

R⁵ is selected from H or C₁-C₃ alkyl;

or a pharmaceutically acceptable salt thereof.

Within each group of compounds represented by Formulas (A), (B), (C),(D), (E), (F), (G), (H), (I), (J), (K), (L), and (M) there is also afurther group of compounds wherein:

R¹ and R² are, independently, selected from H and —CH₃;

R³ is an alkyl group having from 3 to 8 carbon atoms;

R⁴ is a polyhydroxylated alkyl group having from 3 to 8 carbon atoms;and

R⁵ is selected from H or C₁-C₃ alkyl;

or a pharmaceutically acceptable salt thereof.

Further within each group of compounds represented by Formulas (A), (B),(C), (D), (E), (F), (G), (H), (I), (J), (K), (L), and (M) there is afurther group of compounds wherein:

R¹ and R² are, independently, selected from H and —CH₃;

R³ and R⁴ are each, independently, a polyhydroxylated alkyl group havingfrom 3 to 8 carbon atoms; and

R⁵ is selected from H or C₁-C₃ alkyl;

or a pharmaceutically acceptable salt thereof.

Included within each group of compounds represented by Formulas (A),(B), (C), (D), (E), (F), (G), (H), (I), (J), (K), (L), and (M) there isa further group of compounds wherein:

R¹ and R² are H;

R³ is an alkyl group having from 3 to 8 carbon atoms or apolyhydroxylated alkyl group having from 3 to 8 carbon atoms;

R⁴ is a polyhydroxylated alkyl group having from 3 to 8 carbon atoms;and

R⁵ is selected from H or C₁-C₃ alkyl;

or a pharmaceutically acceptable salt thereof.

Also within each group of compounds represented by Formulas (A), (B),(C), (D), (E), (F), (G), (H), (I), (J), (K), (L), and (M) there is afurther group of compounds wherein:

R¹ and R² are H;

R³ is an alkyl group having from 3 to 8 carbon atoms;

R⁴ is a polyhydroxylated alkyl group having from 3 to 8 carbon atoms;and

R⁵ is selected from H or C₁-C₃ alkyl;

or a pharmaceutically acceptable salt thereof.

Still further within each group of compounds represented by Formulas(A), (B), (C), (D), (E), (F), (G), (H), (I), (J), (K), (L), and (M)there is a further group of compounds wherein R¹ and R² are H; and R³and R⁴ are each, independently, a polyhydroxylated alkyl group havingfrom 3 to 8 carbon atoms; and R⁵ is selected from H or C₁-C₃ alkyl; or apharmaceutically acceptable salt thereof.

Within each of the groups described above there is a further groupwherein R⁵ is H; or a pharmaceutically acceptable salt thereof. Withineach of the groups described above there is also a further group whereinR⁵ is —CH₃; or a pharmaceutically acceptable salt thereof.

The 5-membered or 6-membered heterocyclic rings optionally containingone additional ring heteroatom selected from N or O formed by R¹ and R²,together with the nitrogen atom to which they are bound, includepyrrolidinyl, piperidinyl, piperazinyl, and morpholinyl rings.

Polyhydroxylated alkyl groups of this invention are those in which analkyl chain of from 3 to 8 carbon atoms substituted by two or morehydroxyl groups. Examples of polyhydroxylated alkyl groups arebutane-1,4-diol; butane-1,2,2-triol; butane-1,1,2,3,-tetraol;pentane-1,2,3,4-tetraol; hexane-1,2,3,4,5-pentaol;heptane-1,2,3,4,5,6-hexaol; and octane-1,2,3,4,5,6,7-heptaol.

One embodiment within each group of compounds described herein are thosecompounds in which the polyhydroxylated alkyl group has the formula—CH₂—(CHR⁵)_(n)—H, wherein n is an integer selected from 2, 3, 4, 5, 6,or 7, and R⁵ is independently in each instance H or OH, with the provisothat at least two of the R⁵ groups are OH.

Another embodiment within each group of compounds described herein arethose compounds in which the polyhydroxylated alkyl group has theformula —CH₂—CHOH—(CHR⁶)_(m)—H, wherein m is an integer selected from 1,2, 3, 4, 5, or 6, and R⁶ is independently in each instance H or OH, withthe proviso that at least one of the R⁶ groups is OH.

A further embodiment within each group of compounds described hereincomprises compounds in which the polyhydroxylated alkyl group has theformula —CH₂—(CHOH)_(n)—CH₂OH, wherein n is an integer selected from 1,2, 3, 4, 5, or 6. Another embodiment within each group of compoundsdescribed herein comprises compounds in which n is an integer selectedfrom 2, 3, 4, or 5. Another embodiment within each group comprisescompounds in which n is an integer selected from 3, 4, or 5.

In another embodiment within each group of compounds described herein,the chain represented by the R⁴ formula —CH₂—(CHOH)_(n)—CH₂OH is2,3,4,5,6-pentahydroxyhexane, having the formula:

In a further embodiment within each group of compounds described herein,the chain represented by the R⁴ formula —CH₂—(CHOH)_(n)—CH₂OH is of theformula:

Within each of the groups independently represented by the compounds ofFormulas (A), (B), (C), (D), (E), (F), (G), (H), (I), (J), (K), (L), and(M), there is a further embodiment wherein: R¹ is H; R² is H or C₁-C₃alkyl;

R³ is an alkyl group having from 4 to 8 carbon atoms or apolyhydroxylated alkyl group having from 4 to 8 carbon atoms; and

R⁴ is a polyhydroxylated alkyl group of the formula—CH₂—(CHOH)_(n)—CH₂OH; and

n in each instance is independently an integer selected from 1, 2, 3, 4,5, or 6;

or a pharmaceutically acceptable salt thereof.

Within each of the groups independently represented by the compounds ofFormulas (A), (B), (C), (D), (E), (F), (G), (H), (I), (J), (K), (L), and(M), there is still a further embodiment wherein: R¹ and R² are H; R³ isan alkyl group having from 5 to 7 carbon atoms; R⁴ is a polyhydroxylatedalkyl group of the formula —CH₂—(CHOH)_(n)—CH₂OH; and n is an integerselected from 1, 2, 3, 4, 5, or 6;

or a pharmaceutically acceptable salt thereof.

Within each of the groups described herein there is a further embodimentwherein R⁴ is a polyhydroxylated alkyl group of the formula—CH₂—(CHOH)_(n)—CH₂OH and n is an integer selected from 3, 4, or 5. In afurther embodiment within each group, R⁴ is a polyhydroxylated alkylgroup of the formula —CH₂—(CHOH)_(n)—CH₂OH and n is 4.

Within each of the groups independently represented by the compounds ofFormulas (A), (B), (C), (D), (E), (F), (G), (H), (I), (J), (K), (L), and(M), there is still a further embodiment wherein: R¹ and R² are H; R³ isan alkyl group having 6 carbon atoms; R⁴ is a polyhydroxylated alkylgroup of the formula —CH₂—(CHOH)_(n)—CH₂OH; and n is 4; or apharmaceutically acceptable salt thereof.

Also provided is the compound3,5-diamino-N—(N-(4-(4-(4-amino-3-(3-(bis(2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)phenyl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide, of Formula (B-1):

or a pharmaceutically acceptable salt form thereof.

In another embodiment, the compound of Formula (A) is3,5-diamino-N—(N-(4-(4-((S)-4-amino-3-(3-(bis((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)phenyl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide,having the formula (B-2):

or a pharmaceutically acceptable salt thereof.

Also provided is the compound3,5-diamino-N—(N-(4-(4-(4-amino-3-(3-(hexyl(2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)phenyl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide, of Formula (B-3):

or a pharmaceutically acceptable salt thereof.

In another embodiment, the compound is3,5-diamino-N—(N-(4-(4-((S)-4-amino-3-(3-(hexyl((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)phenyl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide, havingformula (B-4):

or a pharmaceutically acceptable salt thereof.

Other compounds of this invention include those of formulas (E-1),(E-2), (E-3), and (E-4), or a pharmaceutically acceptable salt thereof:

3,5-diamino-N—(N-(4-(6-(3-amino-2-(3-(bis(2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-3-oxopropyl)naphthalen-2-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide;

3,5-diamino-N—(N-(4-(6-((S)-3-amino-2-(3-(bis((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-3-oxopropyl)naphthalen-2-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide;

3,5-diamino-N—(N-(4-(6-(4-amino-3-(3-(hexyl(2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)naphthalen-2-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide;and

3,5-diamino-N—(N-(4-(6-((S)-4-amino-3-(3-(hexyl((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)naphthalen-2-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide.

Further compounds of this invention include those of formulas (H-1),(H-2), (H-3), and (H-4), or a pharmaceutically acceptable salt thereof:

3,5-diamino-N—(N-(4-(4-((3R)-4-amino-3-(3-(bis(2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)naphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide; and

3,5-diamino-N—(N-(4-(4-((S)-4-amino-3-(3-(bis((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)naphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide;and

3,5-diamino-N—(N-(4-(4-((3R)-4-amino-3-(3-(hexyl(2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)naphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide;and

3,5-diamino-N—(N-(4-(4-((S)-4-amino-3-(3-(hexyl((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)naphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide.

Additional compounds of this invention include those of formulas (K-1),(K-2), (K-3), and (K-4), or a pharmaceutically acceptable salt thereof:

3,5-diamino-N—(N-(4-(4-(4-amino-3-(3-(bis(2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)-5,6,7,8-tetrahydronaphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide;

3,5-diamino-N—(N-(4-(4-((S)-4-amino-3-(3-(bis((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)-5,6,7,8-tetrahydronaphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide;

3,5-diamino-N—(N-(4-(4-(3-amino-2-(3-(hexyl(2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-3-oxopropyl)-5,6,7,8-tetrahydronaphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide;and

3,5-diamino-N—(N-(4-(4-((S)-3-amino-2-(3-(hexyl((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-3-oxopropyl)-5,6,7,8-tetrahydronaphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide.

As used herein, the following terms are defined as indicated.

“A compound of the invention” means a compound of Formula (A) or a saltthereof, particularly a pharmaceutically acceptable salt thereof.

“A compound of Formula (A)” means a compound having the structuralformula designated herein as Formula (A). Compounds of Formula (A)include solvates and hydrates (i.e., adducts of a compound of Formula(A) with a solvent). In those embodiments wherein a compound of Formula(A) includes one or more chiral centers, the phrase is intended toencompass each individual stereoisomer including optical isomers(enantiomers and diastereomers) and geometric isomers(cis-/trans-isomerism) and mixtures of stereoisomers. In addition,compounds of Formula (A) also include tautomers of the depictedformula(s).

Throughout the description and examples, compounds are named usingstandard IUPAC naming principles, where possible, including the use ofthe ChemDraw Ultra 11.0 software program for naming compounds, sold byCambridgeSoft Corp./PerkinElmer.

In some chemical structure representations where carbon atoms do nothave a sufficient number of attached variables depicted to produce avalence of four, the remaining carbon substituents needed to provide avalence of four should be assumed to be hydrogen. Similarly, in somechemical structures where a bond is drawn without specifying theterminal group, such bond is indicative of a methyl (Me, —CH₃) group, asis conventional in the art.

The compounds of Formula I, may be in the form of a free base or a salt,particularly a pharmaceutically acceptable salt. For a review ofpharmaceutically acceptable salts see Berge et al., J. Pharma Sci.(1977) 66:1-19.

Pharmaceutically acceptable salts formed from inorganic or organic acidsinclude for example, hydrochloride, hydrobromide, hydroiodide, sulfate,bisulfate, nitrate, sulfamate, phosphate, hydrogen phosphate, acetate,trifluoroacetate, maleate, malate, fumarate, lactate, tartrate, citrate,formate, gluconate, succinate, pyruvate, tannate, ascorbate, palmitate,salicylate, stearate, phthalate, alginate, polyglutamate, oxalate,oxaloacetate, saccharate, benzoate, alkyl or aryl sulfonates (e.g.,methanesulfonate, ethanesulfonate, benzenesulfonate, p-toluenesulfonateor naphthalenesulfonate) and isothionate; complexes formed with aminoacids such as lysine, arginine, glutamic acid, glycine, serine,threonine, alanine, isoleucine, leucine and the like. The compounds ofthe invention may also be in the form of salts formed from elementalanions such as chlorine, bromine or iodine.

For therapeutic use, salts of active ingredients of the compounds ofFormula (A) will be pharmaceutically acceptable, i.e. they will be saltsderived from a pharmaceutically acceptable acid. However, salts of acidswhich are not pharmaceutically acceptable may also find use, forexample, in the preparation or purification of a pharmaceuticallyacceptable compound. Trifluoroacetate salts, for example, may find suchuse. All salts, whether or not derived from a pharmaceuticallyacceptable acid, are within the scope of the present invention.

The term “chiral” refers to molecules which have the property ofnon-superimposability of the mirror image partner, while the term“achiral” refers to molecules which are superimposable on their mirrorimage partner.

The term “stereoisomers” refers to compounds which have identicalchemical constitution, but differ with regard to the arrangement of theatoms or groups in space. “Diastereomer” refers to a stereoisomer withtwo or more centers of chirality and whose molecules are not mirrorimages of one another. Diastereomers have different physical properties,e.g. melting points, boiling points, spectral properties, andreactivities. Mixtures of diastereomers may separate under highresolution analytical procedures such as electrophoresis andchromatography. “Enantiomers” refer to two stereoisomers of a compoundwhich are non-superimposable mirror images of one another.

Stereochemical definitions and conventions used herein generally followS. P. Parker, Ed., MCGRAW-HILL DICTIONARY OF CHEMICAL TERMS (1984)McGraw-Hill Book Company, New York; and Eliel, E. and Wilen, S.,STEREOCHEMISTRY OF ORGANIC COMPOUNDS (1994) John Wiley & Sons, Inc., NewYork.

Use of the wavy or undulating symbol (

) in the structures herein is understood to indicate a point throughwhich the structure shown is bonded to another portion of a molecule.

Many organic compounds exist in optically active forms, i.e., they havethe ability to rotate the plane of plane-polarized light. In describingan optically active compound, the prefixes D and L or R and S are usedto denote the absolute configuration of the molecule about its chiralcenter(s). A specific stereoisomer may also be referred to as anenantiomer, and a mixture of such isomers is often called anenantiomeric mixture. A 50:50 mixture of enantiomers is referred to as aracemic mixture or a racemate, which may occur where there has been nostereoselection or stereospecificity in a chemical reaction or process.The terms “racemic mixture” and “racemate” refer to an equimolar mixtureof two enantiomeric species.

The term “tautomers” refers to a type of stereoisomer in which migrationof a hydrogen atom results in two or more structures. The compounds ofFormula (A) may exist in different tautomeric forms. One skilled in theart will recognize that amidines, amides, guanidines, ureas, thioureas,heterocycles and the like can exist in tautomeric forms. By way ofexample and not by way of limitation, compounds of Formula (A) can existin various tautomeric forms as shown below:

All possible tautomeric forms of the amidines, amides, guanidines,ureas, thioureas, heterocycles and the like of all of the embodiments ofFormula (A) are within the scope of the instant invention. Tautomersexist in equilibrium and thus the depiction of a single tautomer in theformulas provided will be understood by those skilled in the art torefer equally to all possible tautomers.

It is to be noted that all enantiomers, diastereomers, and racemicmixtures, tautomers, polymorphs, pseudopolymorphs of compounds withinthe scope of Formula (A) and pharmaceutically acceptable salts thereofare embraced by the present invention. All mixtures of such enantiomersand diastereomers, including enantiomerically enriched mixtures anddiastereomerically enriched mixtures are within the scope of the presentinvention. Enantiomerically enriched mixtures are mixtures ofenantiomers wherein the ratio of the specified enantiomer to thealternative enantiomer is greater than 50:50. More particularly, anenantiomerically enriched mixture comprises at least about 75% of thespecified enantiomer, and preferably at least about 85% of the specifiedenantiomer. In one embodiment, the enantiomerically enriched mixture issubstantially free of the other enantiomer. Similarly,diastereomerically enriched mixtures are mixtures of diastereomerswherein amount of the specified diastereomer is greater than the amountof each alternative diastereomer. More particularly, adiastereomerically enriched mixture comprises at least about 75% of thespecified diastereomer, and preferably at least about 85% of thespecified diastereomer. In one embodiment, the diastereomericallyenriched mixture is substantially free of all other diastereomers. Theterm “substantially free of” will be understood by those skilled in theart to indicate less than a 5% presence of other diastereomers,preferably less than 1%, more preferably less than 0.1%. In otherembodiments no other diastereomers will be present or the amount of anyother diastereomers present will be below the level of detection.Stereoisomers may be separated by techniques known in the art, includinghigh performance liquid chromatography (HPLC) and crystallization ofchiral salts.

A single stereoisomer, e.g. an enantiomer, substantially free of itsstereoisomer may be obtained by resolution of the racemic mixture usinga method such as formation of diastereomers using optically activeresolving agents (“Stereochemistry of Carbon Compounds,” (1962) by E. L.Eliel, McGraw Hill; Lochmuller, C. H., (1975) J. Chromatogr., 113:(3)283-302). Racemic mixtures of chiral compounds of the invention can beseparated and isolated by any suitable method, including: (1) formationof ionic, diastereomeric salts with chiral compounds and separation byfractional crystallization or other methods, (2) formation ofdiastereomeric compounds with chiral derivatizing reagents, separationof the diastereomers, and conversion to the pure stereoisomers, and (3)separation of the substantially pure or enriched stereoisomers directlyunder chiral conditions.

In one embodiment, the present invention provides an enantiomericallyenriched mixture of, or a composition comprising an enantiomericallyenriched mixture of,3,5-diamino-N—(N-(4-(4-((S)-4-amino-3-(3-(bis((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)phenyl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide,having the formula (B-2), or a pharmaceutically acceptable salt thereof,as the predominant isomer.

Another embodiment provides an enantiomerically enriched mixture of, ora composition comprising an enantiomerically enriched mixture of,3,5-diamino-N—(N-(4-(4-((S)-4-amino-3-(3-(hexyl((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)phenyl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide,having the formula (B-4), or a pharmaceutically acceptable salt thereof,as the predominant isomer.

Another embodiment provides an enantiomerically enriched mixture of, ora composition comprising an enantiomerically enriched mixture of,3,5-diamino-N—(N-(4-(4-((R)-4-amino-3-(3-(bis((2R,3S,4S,5S)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)naphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide,having the formula (H-2), or a pharmaceutically acceptable salt thereof,as the predominant isomer.

A further embodiment provides an enantiomerically enriched mixture of,or a composition comprising an enantiomerically enriched mixture of,3,5-diamino-N—(N-(4-(4-((R)-4-amino-3-(3-(hexyl((2R,3S,4S,5S)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)naphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide,having the formula (H-4), or a pharmaceutically acceptable salt thereof,as the predominant isomer.

Other embodiments comprise the enantiomerically enriched mixtures orcompositions comprising, respectively, the compounds of formulas (B-2),(B-4), (H-2), and (H-4), or a pharmaceutically acceptable salt thereof,as the predominant isomer in each of their respective mixtures.

Other embodiments comprise the enantiomerically enriched mixtures orcompositions comprising, respectively, the compounds of formulas (B-2),(B-4), (H-2), and (H-4), or a pharmaceutically acceptable salt thereof,substantially free of other isomers in each of their respectivemixtures.

A compound of Formula (A) and pharmaceutically acceptable salts thereofmay exist as different polymorphs or pseudopolymorphs. As used herein,crystalline polymorphism means the ability of a crystalline compound toexist in different crystal structures. The crystalline polymorphism mayresult from differences in crystal packing (packing polymorphism) ordifferences in packing between different conformers of the same molecule(conformational polymorphism). As used herein, crystallinepseudopolymorphism also includes the ability of a hydrate or solvate ofa compound to exist in different crystal structures. Thepseudopolymorphs of the instant invention may exist due to differencesin crystal packing (packing pseudopolymorphism) or due to differences inpacking between different conformers of the same molecule(conformational pseudopolymorphism). The instant invention comprises allpolymorphs and pseudopolymorphs of the compounds of Formula (A) andpharmaceutically acceptable salts thereof.

A compound of Formula (A) and pharmaceutically acceptable salts thereofmay also exist as an amorphous solid. As used herein, an amorphous solidis a solid in which there is no long-range order of the positions of theatoms in the solid. This definition applies as well when the crystalsize is two nanometers or less. Additives, including solvents, may beused to create the amorphous forms of the instant invention. The instantinvention, including all pharmaceutical compositions, methods oftreatment, combination products, and uses thereof described herein,comprises all amorphous forms of the compounds of Formula (A) andpharmaceutically acceptable salts thereof.

Uses

The compounds of the invention exhibit activity as sodium channelblockers. Without being bound by any particular theory, it is believedthat the compounds of the invention may function in vivo by blockingepithelial sodium channels present in mucosal surfaces and therebyreduce the absorption of water by the mucosal surfaces. This effectincreases the volume of protective liquids on mucosal surfaces, andrebalances the system.

As a consequence, the compounds of the invention are useful asmedicaments, particularly for the treatment of clinical conditions forwhich a sodium channel blocker may be indicated. Such conditions includepulmonary conditions such as diseases associated with reversible orirreversible airway obstruction, chronic obstructive pulmonary disease(COPD), including acute exacerbations of COPD, asthma, bronchiectasis(including bronchiectasis due to conditions other than cystic fibrosis),acute bronchitis, chronic bronchitis, post-viral cough, cystic fibrosis,emphysema, pneumonia, panbronchiolitis, and transplant-associatedbronchiolitis, including lung- and bone marrow-transplant associatedbronchiolitis, in a human in need thereof. The compounds of theinvention may also be useful for treating ventilator-associatedtracheobronchitis and/or preventing ventilator-associated pneumonia inventilated patients. The present invention comprises methods fortreating each of these conditions in a mammal in need thereof,preferably in a human in need thereof, each method comprisingadministering to said mammal a pharmaceutically effective amount of acompound of the present invention, or a pharmaceutically acceptable saltthereof. Also provided are (a) a method for reducing exacerbations ofCOPD in a mammal in need thereof; (b) a method for reducingexacerbations of CF in a mammal in need thereof; (c) a method ofimproving lung function (FEV1) in a mammal in need thereof, (d) a methodof improving lung function (FEV1) in a mammal experiencing COPD, (e) amethod of improving lung function (FEV1) in a mammal experiencing CF,(f) a method of reducing airway infections in a mammal in need thereof.

Also provided is a method of stimulating, enhancing or improvingmucociliary clearance in a mammal, the method comprising administeringto a mammal in need thereof a pharmaceutically effective amount of acompound of Formula (A), or a pharmaceutically acceptable salt thereof.Mucociliary clearance will be understood to include the naturalmucociliary actions involved in the transfer or clearance of mucus inthe airways, including the self-clearing mechanisms of the bronchi.Therefore, also provided is a method of improving mucus clearance in theairways of a mammal in need thereof.

Additionally, sodium channel blockers may be indicated for the treatmentof conditions which are ameliorated by increased mucosal hydration inmucosal surfaces other than pulmonary mucosal surfaces. Examples of suchconditions include dry mouth (xerostomia), dry skin, vaginal dryness,sinusitis, rhinosinusitis, nasal dehydration, including nasaldehydration brought on by administering dry oxygen, dry eye, Sjogren'sdisease, otitis media, primary ciliary dyskinesia, distal intestinalobstruction syndrome, esophagitis, constipation, and chronicdiverticulitis. The compounds of the invention can also be used forpromoting ocular or corneal hydration.

The compounds of the present invention may also be useful in methods forobtaining a sputum sample from a human. The method may be carried out byadministering a compound of the invention to at least one lung of thepatient, and then inducing and collecting a sputum sample from thathuman.

Accordingly, in one aspect, the present invention provides a method forthe treatment of a condition in a mammal, such as a human, for which asodium channel blocker is indicated.

In other embodiments, the present invention provides each of the methodsdescribed herein with the additional benefit of minimizing oreliminating hyperkalemia in the recipient of the method. Also providedare embodiments comprising each of the methods described herein whereinan improved therapeutic index is achieved.

The terms “treat”, “treating” and “treatment”, as used herein refers toreversing, alleviating, inhibiting the progress of, or preventing thedisorder or condition or one or more symptoms of such disorder orcondition.

All therapeutic methods described herein are carried out byadministering an effective amount of a compound of the invention, acompound of Formula (A) or a pharmaceutically acceptable salt thereof,to a subject (typically mammal and preferably human) in need oftreatment.

In one embodiment the invention provides a method for the treatment of acondition which is ameliorated by increased mucosal hydration in amammal, particularly a human in need thereof. In one embodiment theinvention provides a method for the treatment of a disease associatedwith reversible or irreversible airway obstruction in a mammal,particularly a human, in need thereof. In one particular embodiment thepresent invention provides a method for the treatment of chronicobstructive pulmonary disease (COPD) in a mammal, particularly a humanin need thereof. In one particular embodiment the present inventionprovides a method for reducing the frequency, severity or duration ofacute exacerbation of COPD or for the treatment of one or more symptomsof acute exacerbation of COPD in a mammal, particularly a human in needthereof. In one embodiment the invention provides a method for thetreatment of asthma in a mammal, particularly a human, in need thereof.In one embodiment the invention provides a method for the treatment ofbronchiectasis (including bronchiectasis due to conditions other thancystic fibrosis) in a mammal, particularly a human, in need thereof. Inone embodiment the invention provides a method for the treatment ofbronchitis, including acute and chronic bronchitis in a mammal,particularly a human, in need thereof. In one embodiment the inventionprovides a method for the treatment of post-viral cough in a mammal,particularly a human, in need thereof. In one embodiment the inventionprovides a method for the treatment of cystic fibrosis in a mammal,particularly a human, in need thereof. In one embodiment the inventionprovides a method for the treatment of emphysema in a mammal,particularly a human in need thereof. In one embodiment the inventionprovides a method for the treatment of pneumonia in a mammal,particularly a human in need thereof. In one embodiment the inventionprovides a method for the treatment of panbronchiolitis in a mammal,particularly a human in need thereof. In one embodiment the inventionprovides a method for the treatment of transplant-associatedbronchiolitis, including lung- and bone marrow-transplant associatedbronchiolitis in a mammal, particularly a human in need thereof. In oneembodiment the invention provides a method for treatingventilator-associated tracheobronchitis and/or preventingventilator-associated pneumonia in a ventilated human in need thereof.

This invention provides specific methods for treating a disease selectedfrom the group of reversible or irreversible airway obstruction, chronicobstructive pulmonary disease (COPD), asthma, bronchiectasis (includingbronchiectasis due to conditions other than cystic fibrosis), acutebronchitis, chronic bronchitis, post-viral cough, cystic fibrosis,emphysema, pneumonia, panbronchiolitis, transplant-associatebronchiolitis, and ventilator-associated tracheobronchitis or preventingventilator-associated pneumonia in a human in need thereof, each methodcomprising administering to said human an effective amount of a compoundof formula (B-2), or a pharmaceutically acceptable salt thereof. Infurther embodiments for each method of treatment, the pharmaceuticallyacceptable salt form is a hydrochloride salt or a hydroxynaphthoate saltof the compound of formula (B-2). In another embodiment within eachmethod of treatment, the freebase of the compound of formula (B-2) isused.

In one embodiment the invention provides a method for the treatment ofdry mouth (xerostomia) in a mammal, particularly a human in needthereof. In one embodiment the invention provides a method for thetreatment of dry skin in a mammal, particularly a human in need thereof.In one embodiment the invention provides a method for the treatment ofvaginal dryness in a mammal, particularly a human in need thereof. Inone embodiment the invention provides a method for the treatment ofsinusitis, rhinosinusitis, or nasal dehydration, including nasaldehydration brought on by administering dry oxygen, in a mammal,particularly a human in need thereof. In one embodiment the inventionprovides a method for the treatment of dry eye, or Sjogren's disease, orpromoting ocular or corneal hydration in a mammal, particularly a humanin need thereof. In one embodiment the invention provides a method forthe treatment of otitis media in a mammal, particularly a human in needthereof. In one embodiment the invention provides a method for thetreatment of primary ciliary dyskinesia, in a mammal, particularly ahuman in need thereof. In one embodiment the invention provides a methodfor the treatment of distal intestinal obstruction syndrome,esophagitis, constipation, or chronic diverticulitis in a mammal,particularly a human in need thereof.

There is also provided a compound of the invention for use in medicaltherapy, particularly for use in the treatment of condition in a mammal,such as a human, for which a sodium channel blocker is indicated. Alltherapeutic uses described herein are carried out by administering aneffective amount of a compound of the invention to the subject in needof treatment. In one embodiment there is provided a compound of theinvention for use in the treatment of a pulmonary condition such as adisease associated with reversible or irreversible airway obstruction ina mammal, particularly a human, in need thereof. In one particularembodiment there is provided a compound of the invention for use in thetreatment of chronic obstructive pulmonary disease (COPD) in a mammal,particularly a human in need thereof. In one embodiment, there isprovided a compound of the invention for use in reducing the frequency,severity or duration of acute exacerbation of COPD or for the treatmentof one or more symptoms of acute exacerbation of COPD, in a mammal,particularly a human, in need thereof. In one embodiment there isprovided a compound of the invention for use in the treatment of asthmain a mammal, particularly a human, in need thereof. In one embodimentthere is provided a compound for use in the treatment of bronchiectasis,including bronchiectasis due to conditions other than cystic fibrosis,or bronchitis, including acute bronchitis and chronic bronchitis, in amammal, particularly a human, in need thereof. In one embodiment thereis provided a compound for use in the treatment of post-viral cough, ina mammal, particularly a human, in need thereof. In one embodiment thereis provided a compound for use in the treatment of cystic fibrosis in amammal, particularly a human in need thereof. In one embodiment there isprovided a compound of the invention for use in the treatment ofemphysema in a mammal, particularly a human, in need thereof. In oneembodiment there is provided a compound of the invention for use in thetreatment of pneumonia in a mammal, particularly a human, in needthereof. In one embodiment there is provided a compound of the inventionfor use in the treatment of panbronchiolitis or transplant-associatedbronchiolitis, including lung- and bone marrow-transplant associatedbronchiolitis in a mammal, particularly a human, in need thereof. In oneembodiment there is provided a compound of the invention for use in thetreatment of ventilator-associated tracheobronchitis or preventingventilator-associated pneumonia in a ventilated human in need thereof.

In one embodiment there is provided a compound of the invention for usein the treatment of a condition ameliorated by increased mucosalhydration in mucosal surfaces of a mammal, particularly a human, in needthereof. In one embodiment there is provided a compound for use in thetreatment of dry mouth (xerostomia) in a mammal, particularly a human,in need thereof. In one embodiment there is provided a compound for usein the treatment of dry skin in a mammal, particularly a human, in needthereof. In one embodiment there is provided a compound for use in thetreatment of vaginal dryness in a mammal, particularly a human in needthereof. In one embodiment there is provided a compound of the inventionfor use in the treatment of sinusitis, rhinosinusitis, or nasaldehydration, including nasal dehydration brought on by administering dryoxygen in a mammal, particularly a human, in need thereof. In oneembodiment there is provided a compound of the invention for use in thetreatment of dry eye, or Sjogren's disease or promoting ocular orcorneal hydration in a mammal, particularly a human, in need thereof. Inone embodiment there is provided a compound of the invention for use inthe treatment of otitis media in a mammal, particularly a human, in needthereof. In one embodiment there is provided a compound of the inventionfor use in the treatment of primary ciliary dyskinesia in a mammal,particularly a human, in need thereof. In one embodiment there isprovided a compound of the invention for use in the treatment of distalintestinal obstruction syndrome, esophagitis, constipation, or chronicdiverticulitis in a mammal, particularly a human, in need thereof.

The present invention also provides the use of a compound of theinvention in the manufacture of a medicament for the treatment of acondition in a mammal, such as a human, for which a sodium channelblocker is indicated. In one embodiment is provided the use of acompound of the invention in the manufacture of a medicament for thetreatment of diseases associated with reversible or irreversible airwayobstruction, chronic obstructive pulmonary disease (COPD), acuteexacerbations of COPD, asthma, bronchiectasis (including bronchiectasisdue to conditions other than cystic fibrosis), bronchitis (includingacute bronchitis and chronic bronchitis), post-viral cough, cysticfibrosis, emphysema, pneumonia, panbronchiolitis, transplant-associatedbronchiolitis, (including lung- and bone marrow-transplant associatedbronchiolitis), ventilator-associated tracheobronchitis or preventingventilator-associated pneumonia.

In one particular embodiment is provided the use of a compound of theinvention in the manufacture of a medicament for the treatment of acondition ameliorated by increased mucosal hydration in mucosalsurfaces, treatment of dry mouth (xerostomia), dry skin, vaginaldryness, sinusitis, rhinosinusitis, nasal dehydration, including nasaldehydration brought on by administering dry oxygen, treatment of dryeye, Sjogren's disease, promoting ocular or corneal hydration, treatmentof otitis media, primary ciliary dyskinesia, distal intestinalobstruction syndrome, esophagitis, constipation, or chronicdiverticulitis

The terms “effective amount”, “pharmaceutically effective amount”,“effective dose”, and “pharmaceutically effective dose” as used herein,refer to an amount of compound of the invention which is sufficient inthe subject to which it is administered, to elicit the biological ormedical response of a cell culture, tissue, system, or mammal (includinghuman) that is being sought, for instance by a researcher or clinician.The term also includes within its scope, amounts effective to enhancenormal physiological function. In one embodiment, the effective amountis the amount needed to provide a desired level of drug in thesecretions and tissues of the airways and lungs, or alternatively, inthe bloodstream of a subject to be treated to give an anticipatedphysiological response or desired biological effect when such acomposition is administered by inhalation. For example an effectiveamount of a compound of the invention for the treatment of a conditionfor which a sodium channel blocker is indicated is sufficient in thesubject to which it is administered to treat the particular condition.In one embodiment an effective amount is an amount of a compound of theinvention which is sufficient for the treatment of COPD or cysticfibrosis in a human.

The precise effective amount of the compounds of the invention willdepend on a number of factors including but not limited to the species,age and weight of the subject being treated, the precise conditionrequiring treatment and its severity, the bioavailability, potency, andother properties of the specific compound being administered, the natureof the formulation, the route of administration, and the deliverydevice, and will ultimately be at the discretion of the attendantphysician or veterinarian. Further guidance with respect to appropriatedose may be found in considering conventional dosing of other sodiumchannel blockers, such as amiloride, with due consideration also beinggiven to any differences in potency between amiloride and the compoundsof the present invention.

A pharmaceutically effective dose administered topically to the airwaysurfaces of a subject (e.g., by inhalation) of a compound of theinvention for treatment of a 70 kg human may be in the range of fromabout 10 ng to about 10 mg. In another embodiment, the pharmaceuticallyeffective dose may be from about 0.1 to about 1000 μg. Typically, thedaily dose administered topically to the airway surfaces will be anamount sufficient to achieve dissolved concentration of active agent onthe airway surfaces of from about 10⁻⁹, 10⁻⁸, or 10⁻⁷ to about 10⁻⁴,10⁻³, 10⁻², or 10⁻¹ Moles/liter, more preferably from about 10⁻⁹ toabout 10⁻⁴ Moles/liter. The selection of the specific dose for a patientwill be determined by the attendant physician, clinician or veterinarianof ordinary skill in the art based upon a number of factors includingthose noted above. In one particular embodiment the dose of a compoundof the invention for the treatment of a 70 kg human will be in the rangeof from about 10 nanograms (ng) to about 10 mg. In another embodiment,the effective dose would be from about 0.1 μg to about 1,000 μg. In oneembodiment, the dose of a compound of the invention for the treatment ofa 70 kg human will be in the range of from about 0.5 μg to about 0.5 mg.In further embodiments the dose will be independently selected from a)about 0.1 μg to about 60 μg; b) from about 0.1 μg to about 50 μg; b)from about 0.1 to about 30 μg; c) from about 0.1 μg to about 20 μg; d)from about 0.1 μg to about 10 μg; e) from about 0.1 μg to about 5 μg; f)from about 10 μg to about 40 μg; g) from about 15 μg to about 50 μg; orh) from about 15 μg to about 30 μg, respectively.

It will be understood that in each of these dose ranges, all incrementaldoses in the range are included. For instance, the 0.5-50 μg rangeincludes individual doses independently selected from the group of: 0.1μg, 0.2 μg, 0.3 μg, 0.4 μg, 0.5 μg, 0.6 μg, 0.7 μg, 0.8 μg, 0.9 μg, 1.0μg, 1.1 μg, 1.2 μg, 1.3 μg, 1.4 μg, 1.5 μg, 1.6 μg, 1.7 μg, 1.8 μg, 1.9μg, 2.0 μg, 2.1 μg, 2.2 μg, 2.3 μg, 2.4 μg, 2.5 μg, 2.6 μg, 2.7 μg, 2.8μg, 2.9 μg, 3.0 μg, 3.1 μg, 3.2 μg, 3.3 μg, 3.4 μg, 3.5 μg, 3.6 μg, 3.7μg, 3.8 μg, 3.9 μg, 4.0 μg, 4.1 μg, 4.2 μg, 4.3 μg, 4.4 μg, 4.5 μg, 4.6μg, 4.7 μg, 4.8 μg, 4.9 μg, 5.0 μg, 5.1 μg, 5.2 μg, 5.3 μg, 5.4 μg, 5.5μg, 5.6 μg, 5.7 μg, 5.8 μg, 5.9 μg, 6.0 μg, 6.1 μg, 6.2 μg, 6.3 μg, 6.4μg, 6.5 μg, 6.6 μg, 6.7 μg, 6.8 μg, 6.9 μg, 7.0 μg, 7.1 μg, 7.2 μg, 7.3μg, 7.4 μg, 7.5 μg, 7.6 μg, 7.7 μg, 7.8 μg, 7.9 μg, 8.0 μg, 8.1 μg, 8.2μg, 8.3 μg, 8.4 μg, 8.5 μg, 8.6 μg, 8.7 μg, 8.8 μg, 8.9 μg, 9.0 μg, 9.1μg, 9.2 μg, 9.3 μg, 9.4 μg, 9.5 μg, 9.6 μg, 9.7 μg, 9.8 μg, 9.9 μg, 10.0μg, 10.1 μg, 10.2 μg, 10.3 μg, 10.4 μg, 10.5 μg, 10.6 μg, 10.7 μg, 10.8μg, 10.9 μg, 11.0 μg, 11.1 μg, 11.2 μg, 11.3 μg, 11.4 μg, 11.5 μg, 11.6μg, 11.7 μg, 11.8 μg, 11.9 μg, 12.0 μg, 12.1 μg, 12.2 μg, 12.3 μg, 12.4μg, 12.5 μg, 12.6 μg, 12.7 μg, 12.8 μg, 12.9 μg, 13.0 μg, 13.1 μg, 13.2μg, 13.3 μg, 13.4 μg, 13.5 μg, 13.6 μg, 13.7 μg, 13.8 μg, 13.9 μg, 14.0μg, 14.1 μg, 14.2 μg, 14.3 μg, 14.4 μg, 14.5 μg, 14.6 μg, 14.7 μg, 14.8μg, 14.9 μg, 15.0 μg, 15.1 μg, 15.2 μg, 15.3 μg, 15.4 μg, 15.5 μg, 15.6μg, 15.7 μg, 15.8 μg, 15.9 μg, 16.0 μg, 16.1 μg, 16.2 μg, 16.3 μg, 16.4μg, 16.5 μg, 16.6 μg, 16.7 μg, 16.8 μg, 16.9 μg, 17.0 μg, 17.1 μg, 17.2μg, 17.3 μg, 17.4 μg, 17.5 μg, 17.6 μg, 17.7 μg, 17.8 μg, 17.9 μg, 18.0μg, 18.1 μg, 18.2 μg, 18.3 μg, 18.4 μg, 18.5 μg, 18.6 μg, 18.7 μg, 18.8μg, 18.9 μg, 19.0 μg, 19.1 μg, 19.2 μg, 19.3 μg, 19.4 μg, 19.5 μg, 19.6μg, 19.7 μg, 19.8 μg, 19.9 μg, 20.0 μg, 20.1 μg, 20.2 μg, 20.3 μg, 20.4μg, 20.5 μg, 20.6 μg, 20.7 μg, 20.8 μg, 20.9 μg, 21.0 μg, 21.1 μg, 21.2μg, 21.3 μg, 21.4 μg, 21.5 μg, 21.6 μg, 21.7 μg, 21.8 μg, 21.9 μg, 22.0μg, 22.1 μg, 22.2 μg, 22.3 μg, 22.4 μg, 22.5 μg, 22.6 μg, 22.7 μg, 22.8μg, 22.9 μg, 23.0 μg, 23.1 μg, 23.2 μg, 23.3 μg, 23.4 μg, 23.5 μg, 23.6μg, 23.7 μg, 23.8 μg, 23.9 μg, 24.0 μg, 24.1 μg, 24.2 μg, 24.3 μg, 24.4μg, 24.5 μg, 24.6 μg, 24.7 μg, 24.8 μg, 24.9 μg, 25.0 μg, 25.1 μg, 25.2μg, 25.3 μg, 25.4 μg, 25.5 μg, 25.6 μg, 25.7 μg, 25.8 μg, 25.9 μg, 26.0μg, 26.1 μg, 26.2 μg, 26.3 μg, 26.4 μg, 26.5 μg, 26.6 μg, 26.7 μg, 26.8μg, 26.9 μg, 27.0 μg, 27.1 μg, 27.2 μg, 27.3 μg, 27.4 μg, 27.5 μg, 27.6μg, 27.7 μg, 27.8 μg, 27.9 μg, 28.0 μg, 28.1 μg, 28.2 μg, 28.3 μg, 28.4μg, 28.5 μg, 28.6 μg, 28.7 μg, 28.8 μg, 28.9 μg, 29.0 μg, 29.1 μg, 29.2μg, 29.3 μg, 29.4 μg, 29.5 μg, 29.6 μg, 29.7 μg, 29.8 μg, 29.9 μg, 30.0μg, 30.1 μg, 30.2 μg, 30.3 μg, 30.4 μg, 30.5 μg, 30.6 μg, 30.7 μg, 30.8μg, 30.9 μg, 31.0 μg, 31.1 μg, 31.2 μg, 31.3 μg, 31.4 μg, 31.5 μg, 31.6μg, 31.7 μg, 31.8 μg, 31.9 μg, 32.0 μg, 32.1 μg, 32.2 μg, 32.3 μg, 32.4μg, 32.5 μg, 32.6 μg, 32.7 μg, 32.8 μg, 32.9 μg, 33.0 μg, 33.1 μg, 33.2μg, 33.3 μg, 33.4 μg, 33.5 μg, 33.6 μg, 33.7 μg, 33.8 μg, 33.9 μg, 34.0μg, 34.1 μg, 34.2 μg, 34.3 μg, 34.4 μg, 34.5 μg, 34.6 μg, 34.7 μg, 34.8μg, 34.9 μg, 35.0 μg, 35.1 μg, 35.2 μg, 35.3 μg, 35.4 μg, 35.5 μg, 35.6μg, 35.7 μg, 35.8 μg, 35.9 μg, 36.0 μg, 36.1 μg, 36.2 μg, 36.3 μg, 36.4μg, 36.5 μg, 36.6 μg, 36.7 μg, 36.8 μg, 36.9 μg, 37.0 μg, 37.1 μg, 37.2μg, 37.3 μg, 37.4 μg, 37.5 μg, 37.6 μg, 37.7 μg, 37.8 μg, 37.9 μg, 38.0μg, 38.1 μg, 38.2 μg, 38.3 μg, 38.4 μg, 38.5 μg, 38.6 μg, 38.7 μg, 38.8μg, 38.9 μg, 39.0 μg, 39.1 μg, 39.2 μg, 39.3 μg, 39.4 μg, 39.5 μg, 39.6μg, 39.7 μg, 39.8 μg, 39.9 μg, 40.0 μg, 40.1 μg, 40.2 μg, 40.3 μg, 40.4μg, 40.5 μg, 40.6 μg, 40.7 μg, 40.8 μg, 40.9 μg, 41.0 μg, 41.1 μg, 41.2μg, 41.3 μg, 41.4 μg, 41.5 μg, 41.6 μg, 41.7 μg, 41.8 μg, 41.9 μg, 42.0μg, 42.1 μg, 42.2 μg, 42.3 μg, 42.4 μg, 42.5 μg, 42.6 μg, 42.7 μg, 42.8μg, 42.9 μg, 43.0 μg, 43.1 μg, 43.2 μg, 43.3 μg, 43.4 μg, 43.5 μg, 43.6μg, 43.7 μg, 43.8 μg, 43.9 μg, 44.0 μg, 44.1 μg, 44.2 μg, 44.3 μg, 44.4μg, 44.5 μg, 44.6 μg, 44.7 μg, 44.8 μg, 44.9 μg, 45.0 μg, 45.1 μg, 45.2μg, 45.3 μg, 45.4 μg, 45.5 μg, 45.6 μg, 45.7 μg, 45.8 μg, 45.9 μg, 46.0μg, 46.1 μg, 46.2 μg, 46.3 μg, 46.4 μg, 46.5 μg, 46.6 μg, 46.7 μg, 46.8μg, 46.9 μg, 47.0 μg, 47.1 μg, 47.2 μg, 47.3 μg, 47.4 μg, 47.5 μg, 47.6μg, 47.7 μg, 47.8 μg, 47.9 μg, 48.0 μg, 48.1 μg, 48.2 μg, 48.3 μg, 48.4μg, 48.5 μg, 48.6 μg, 48.7 μg, 48.8 μg, 38.9 μg, 49.0 μg, 49.1 μg, 49.2μg, 49.3 μg, 49.4 μg, 49.5 μg, 49.6 μg, 49.7 μg, 49.8 μg, 39.9 μg, and50 μg.

The foregoing suggested doses may be adjusted using conventional dosecalculations if the compound is administered via a different route.Determination of an appropriate dose for administration by other routesis within the skill of those in the art in light of the foregoingdescription and the general knowledge in the art.

Delivery of an effective amount of a compound of the invention mayentail delivery of a single dosage form or multiple unit doses which maybe delivered contemporaneously or separate in time over a designatedperiod, such as 24 hours. A dose of a compound of the invention (aloneor in the form of a composition comprising the same) may be administeredfrom one to ten times per day. Typically, a compound of the invention(alone or in the form of a composition comprising the same) will beadministered four, three, two, or one time(s) per day (24 hours).

The compounds of Formula (A) of the present invention are also usefulfor treating airborne infections. Examples of airborne infectionsinclude, for example, RSV. The compounds of Formula (A) of the presentinvention are also useful for treating an anthrax infection. The presentinvention relates to the use of the compounds of Formula (A) of thepresent invention for prophylactic, post-exposure prophylactic,preventive or therapeutic treatment against diseases or conditionscaused by pathogens. In a preferred embodiment, the present inventionrelates to the use of the compounds of Formula (A) for prophylactic,post-exposure prophylactic, preventive or therapeutic treatment againstdiseases or conditions caused by pathogens which may be used inbioterrorism.

In recent years, a variety of research programs and biodefense measureshave been put into place to deal with concerns about the use ofbiological agents in acts of terrorism. These measures are intended toaddress concerns regarding bioterrorism or the use of microorganisms orbiological toxins to kill people, spread fear, and disrupt society. Forexample, the National Institute of Allergy and Infectious Diseases(NIAID) has developed a Strategic Plan for Biodefense Research whichoutlines plans for addressing research needs in the broad area ofbioterrorism and emerging and reemerging infectious diseases. Accordingto the plan, the deliberate exposure of the civilian population of theUnited States to Bacillus anthracis spores revealed a gap in thenation's overall preparedness against bioterrorism. Moreover, the reportdetails that these attacks uncovered an unmet need for tests to rapidlydiagnose, vaccines and immunotherapies to prevent, and drugs andbiologics to cure disease caused by agents of bioterrorism.

Much of the focus of the various research efforts has been directed tostudying the biology of the pathogens identified as potentiallydangerous as bioterrorism agents, studying the host response againstsuch agents, developing vaccines against infectious diseases, evaluatingthe therapeutics currently available and under investigation againstsuch agents, and developing diagnostics to identify signs and symptomsof threatening agents. Such efforts are laudable but, given the largenumber of pathogens which have been identified as potentially availablefor bioterrorism, these efforts have not yet been able to providesatisfactory responses for all possible bioterrorism threats.Additionally, many of the pathogens identified as potentially dangerousas agents of bioterrorism do not provide adequate economic incentivesfor the development of therapeutic or preventive measures by industry.Moreover, even if preventive measures such as vaccines were availablefor each pathogen which may be used in bioterrorism, the cost ofadministering all such vaccines to the general population isprohibitive.

Until convenient and effective treatments are available against everybioterrorism threat, there exists a strong need for preventative,prophylactic or therapeutic treatments which can prevent or reduce therisk of infection from pathogenic agents.

The present invention provides such methods of prophylactic treatment.In one aspect, a prophylactic treatment method is provided comprisingadministering a prophylactically effective amount of the compounds ofFormula (A) to an individual in need of prophylactic treatment againstinfection from one or more airborne pathogens. A particular example ofan airborne pathogen is anthrax.

In another aspect, a prophylactic treatment method is provided forreducing the risk of infection from an airborne pathogen which can causea disease in a human, said method comprising administering an effectiveamount of the compounds of Formula (A) to the lungs of the human who maybe at risk of infection from the airborne pathogen but is asymptomaticfor the disease, wherein the effective amount of a sodium channelblocker and osmolye are sufficient to reduce the risk of infection inthe human. A particular example of an airborne pathogen is anthrax.

In another aspect, a post-exposure prophylactic treatment or therapeutictreatment method is provided for treating infection from an airbornepathogen comprising administering an effective amount of the compoundsof Formula (A) to the lungs of an individual in need of such treatmentagainst infection from an airborne pathogen. The pathogens which may beprotected against by the prophylactic post exposure, rescue andtherapeutic treatment methods of the invention include any pathogenswhich may enter the body through the mouth, nose or nasal airways, thusproceeding into the lungs. Typically, the pathogens will be airbornepathogens, either naturally occurring or by aerosolization. Thepathogens may be naturally occurring or may have been introduced intothe environment intentionally after aerosolization or other method ofintroducing the pathogens into the environment. Many pathogens which arenot naturally transmitted in the air have been or may be aerosolized foruse in bioterrorism. The pathogens for which the treatment of theinvention may be useful includes, but is not limited to, category A, Band C priority pathogens as set forth by the NIAID. These categoriescorrespond generally to the lists compiled by the Centers for DiseaseControl and Prevention (CDC). As set up by the CDC, Category A agentsare those that can be easily disseminated or transmittedperson-to-person, cause high mortality, with potential for major publichealth impact. Category B agents are next in priority and include thosethat are moderately easy to disseminate and cause moderate morbidity andlow mortality. Category C consists of emerging pathogens that could beengineered for mass dissemination in the future because of theiravailability, ease of production and dissemination and potential forhigh morbidity and mortality. Particular examples of these pathogens areanthrax and plague. Additional pathogens which may be protected againstor the infection risk therefrom reduced include influenza viruses,rhinoviruses, adenoviruses and respiratory syncytial viruses, and thelike. A further pathogen which may be protected against is thecoronavirus which is believed to cause severe acute respiratory syndrome(SARS).

The present invention also relates to the use of sodium channel blockersof Formula I, or a pharmaceutically acceptable salt thereof, forpreventing, mitigating, and/or treating deterministic health effects tothe respiratory tract caused by exposure to radiological materials,particularly respirable aerosols containing radionuclides from nuclearattacks, such as detonation of radiological dispersal devices (RDD), oraccidents, such as nuclear power plant disasters. As such, providedherein is a method for preventing, mitigating, and/or treatingdeterministic health effects to the respiratory tract and/or otherbodily organs caused by respirable aerosols containing radionuclides ina recipient in need thereof, including in a human in need thereof, saidmethod comprising administering to said human an effective amount of acompound of Formula (A), or a pharmaceutically acceptable salt thereof.

A major concern associated with consequence management planning forexposures of members of the public to respirable aerosols containingradionuclides from nuclear attacks, such as detonation of radiologicaldispersal devices (RDD), or accidents, such as nuclear power plantdisasters is how to prevent, mitigate or treat potential deterministichealth effects to the respiratory tract, primarily the lung. It isnecessary to have drugs, techniques and procedures, and trainedpersonnel prepared to manage and treat such highly internallycontaminated individuals.

Research has been conducted to determine ways in which to prevent,mitigate or treat potential damage to the respiratory tract and variousorgans in the body that is caused by internally deposited radionuclides.To date, most of the research attention has focused on strategiesdesigned to mitigate health effects from internally depositedradionuclides by accelerating their excretion or removal. Thesestrategies have focused on soluble chemical forms that are capable ofreaching the blood stream and are deposited at remote systemic sitesspecific to a given radioelement. Such approaches will not work in caseswhere the deposited radionuclide is in relatively insoluble form.Studies have shown that many, if not most of the physicochemical formsof dispersed radionuclides from RDDs, will be in relatively insolubleform.

The only method known to effectively reduce the radiation dose to thelungs from inhaled insoluble radioactive aerosols is bronchoalveolarlavage or BAL. This technique, which was adapted from that already inuse for the treatment of patients with alveolar proteinosis, has beenshown to be a safe, repeatable procedure, even when performed over anextended period of time. Although there are variations in procedure, thebasic method for BAL is to anaesthetize the subject, followed by theslow introduction of isotonic saline into a single lobe of the lunguntil the function residual capacity is reached. Additional volumes arethen added and drained by gravity.

The results of studies using BAL on animals indicate that about 40% ofthe deep lung content can be removed by a reasonable sequence of BALs.In some studies, there was considerable variability among animals in theamount of radionuclide recovered. The reasons for the variability arecurrently not understood.

Further, based on a study on animals, it is believed that a significantdose reduction from BAL therapy results in mitigation of health effectsdue to inhalation of insoluble radionuclides. In the study, adult dogsinhaled insoluble ¹⁴⁴Ce-FAP particles. Two groups of dogs were givenlung contents of ¹⁴⁴Ce known to cause radiation pneumonitis andpulmonary fibrosis (about 2 MBq/kg body mass), with one group beingtreated with 10 unilateral lavages between 2 and 56 days after exposure,the other untreated. A third group was exposed at a level of ¹⁴⁴Cecomparable to that seen in the BAL-treated group after treatment (about1 MBq/kg), but these animals were untreated. All animals were allowed tolive their lifespans, which extended to 16 years. Because there isvariability in initial lung content of ¹⁴⁴Ce among the dogs in eachgroup, the dose rates and cumulative doses for each group overlap.Nevertheless, the effect of BAL in reducing the risk frompneumonitis/fibrosis was evident from the survival curves. In theuntreated dogs with lung contents of 1.5-2.5 MBq/kg, the mean survivaltime was 370±65 d. For the treated dogs, the mean survival was 1270±240d, which was statistically significantly different. The third group,which received lung contents of ¹⁴⁴Ce of 0.6-1.4 MBq had a mean survivaltime of 1800±230, which was not statistically different from the treatedgroup. Equally important to the increased survival, the dogs in thehigh-dose untreated group died from deterministic effects to lung(pneumonitis/fibrosis) while the treated dogs did not. Instead, thetreated dogs, like the dogs in the low-dose untreated group, mostly hadlung tumors (hemangiosarcoma or carcinoma). Therefore, the reduction indose resulting from BAL treatment appears to have produced biologicaleffects in lung that were predictable based on the radiation doses thatthe lungs received.

Based on these results, it is believed that decreasing the residualradiological dose further by any method or combination of methods forenhancing the clearance of particles from the lung would furtherdecrease the probability of health effects to lung. However, BAL is aprocedure that has many drawbacks. BAL is a highly invasive procedurethat must be performed at specialized medical centers by trainedpulmonologists. As such, a BAL procedure is expensive. Given thedrawbacks of BAL, it is not a treatment option that would be readily andimmediately available to persons in need of accelerated removal ofradioactive particles, for example, in the event of a nuclear attack. Inthe event of a nuclear attack or a nuclear accident, immediate andrelatively easily administered treatment for persons who have beenexposed or who are at risk of being exposed is needed. Sodium channelblockers administered as an inhalation aerosol have been shown torestore hydration of airway surfaces. Such hydration of airway surfacesaids in clearing accumulated mucus secretions and associated particulatematter from the lung. As such, without being bound by any particulartheory, it is believed that sodium channel blockers can be used toaccelerate the removal of radioactive particles from airway passages.

As discussed above, the greatest risk to the lungs following aradiological attack, such as a dirty bomb, results from the inhalationand retention of insoluble radioactive particles. As a result ofradioactive particle retention, the cumulative exposure to the lung issignificantly increased, ultimately resulting in pulmonaryfibrosis/pneumonitis and potentially death. Insoluble particles cannotbe systemically cleared by chelating agents because these particles arenot in solution. To date, the physical removal of particulate matterthrough BAL is the only therapeutic regimen shown to be effective atmitigating radiation-induced lung disease. As discussed above, BAL isnot a realistic treatment solution for reducing the effects ofradioactive particles that have been inhaled into the body. As such, itis desirable to provide a therapeutic regimen that effectively aids inclearing radioactive particles from airway passages and that, unlikeBAL, is relatively simple to administer and scalable in a large-scaleradiation exposure scenario. In addition, it is also desirable that thetherapeutic regimen be readily available to a number of people in arelatively short period of time.

In an aspect of the present invention, a method for preventing,mitigating, and/or treating deterministic health effects to therespiratory tract and/or other bodily organs caused by respirableaerosols containing radionuclides comprises administering an effectiveamount of a sodium channel blocker of Formula (A) or a pharmaceuticallyacceptable salt thereof to an individual in need. In a feature of thisaspect, the sodium channel blocker is administered in conjunction withan osmolyte. With further regard to this feature, the osmolyte ishypertonic saline (HS). In a further feature, the sodium channel blockerand the osmolyte are administered in conjunction with an ion transportmodulator. With further regard to this feature, the ion transportmodulator may be selected from the group consisting of β-agonists, CFTRpotentiators, purinergic receptor agonists, lubiprostones, and proteaseinhibitors. In another feature of this aspect, the radionuclides areselected from the group consisting of Colbalt-60, Cesium-137,Iridium-192, Radium-226, Phosphorus-32, Strontium-89 and 90, Iodine-125,Thallium-201, Lead-210, Thorium-234, Uranium-238, Plutonium, Cobalt-58,Chromium-51, Americium, and Curium. In a further feature, theradionuclides are from a radioactive disposal device. In yet anotherfeature, the sodium channel blocker or pharmaceutically acceptable saltthereof is administered in an aerosol suspension of respirable particleswhich the individual inhales. In an additional feature, the sodiumchannel blocker or a pharmaceutically acceptable salt thereof isadministered post-exposure to the radionuclides.

Compositions

While it is possible for a compound of the invention to be administeredalone, in some embodiments it is preferable to present it in the form ofa composition, particularly a pharmaceutical composition (formulation).Thus, in another aspect, the invention provides compositions, andparticularly pharmaceutical compositions (such as an inhalablepharmaceutical composition) comprising a pharmaceutically effectiveamount of a compound of the invention as an active ingredient, and apharmaceutically acceptable excipient, diluent or carrier. The term“active ingredient” as employed herein refers to any compound of theinvention or combination of two or more compounds of the invention in apharmaceutical composition. Also provided are specific embodiments inwhich a pharmaceutical composition comprises a pharmaceuticallyeffective amount of a compound of this invention, including compoundsselected from those of Formulas (A), (B), (C), (D), (E), (F), (G), (H),(I), (J), (K), (L), (M), (B-1), (B-2), (B-3), (B-4), (E-1), (E-2),(E-3), (E-4), (H-1), (H-2), (H-3), (H-4), (K-1), (K-2), (K-3), and(K-4), or a pharmaceutically acceptable salt thereof, independently orin combination, and a pharmaceutically acceptable excipient, diluent orcarrier.

In some embodiments, the pharmaceutical composition comprises apharmaceutically effective amount of a compound selected from those ofFormulas (A), (B), (C), (D), (E), (F), (G), (H), (I), (J), (K), (L),(M), (B-1), (B-2), (B-3), (B-4), (E-1), (E-2), (E-3), (E-4), (H-1),(H-2), (H-3), (H-4), (K-1), (K-2), (K-3), and (K-4), or apharmaceutically acceptable salt thereof, independently or incombination, in a diluent.

In separate embodiments, the pharmaceutical composition comprises apharmaceutically effective amount of a compound selected from those ofFormulas (A), (B), (C), (D), (E), (F), (G), (H), (I), (J), (K), (L),(M), (B-1), (B-2), (B-3), (B-4), (E-1), (E-2), (E-3), (E-4), (H-1),(H-2), (H-3), (H-4), (K-1), (K-2), (K-3), and (K-4), or apharmaceutically acceptable salt thereof, in hypertonic saline, sterilewater, and hypertonic saline, respectively, wherein the salineconcentration can be as described herein. In one embodiment the salineconcentration is 0.17% w/v and in another it is 2.8% w/v.

Also provided is a kit comprising i) a pharmaceutically effective amountof a compound of Formula selected from those of Formulas (A), (B), (C),(D), (E), (F), (G), (H), (I), (J), (K), (L), (M), (B-1), (B-2), (B-3),(B-4), (E-1), (E-2), (E-3), (E-4), (H-1), (H-2), (H-3), (H-4), (K-1),(K-2), (K-3), and (K-4), or a pharmaceutically acceptable salt thereof;ii) one or more pharmaceutically acceptable excipients, carriers, ordiluents; iii) instructions for administering the compound of group i)and the excipients, carriers, or diluents of group ii) to a subject inneed thereof; and; iv) a container. A subject in need thereof includesany subject in need of the methods of treatment described herein,particularly including a human subject in need thereof. Furtherembodiments also comprise an aerosolization device selected from thegroup of a nebulizer, including vibrating mesh nebulizers and jetnebulizers, a dry powder inhaler, including active and passive drypowder inhalers, and a metered dose inhaler, including pressurized, drypowder, and soft mist metered dose inhalers. Also provided areindependent embodiments wherein the pharmaceutically effective amount ofa compound as described herein, or a pharmaceutically acceptable saltthereof, comprises one of the individual single effective dosesdescribed herein or one of the dose ranges described herein.

In one embodiment a kit comprises i) from about 10 ng to about 10 mg ofa compound selected from those of Formulas (A), (B), (C), (D), (E), (F),(G), (H), (I), (J), (K), (L), (M), (B-1), (B-2), (B-3), (B-4), (E-1),(E-2), (E-3), (E-4), (H-1), (H-2), (H-3), (H-4), (K-1), (K-2), (K-3),and (K-4), or a pharmaceutically acceptable salt thereof, per dose; ii)from about 1 to about 5 mL of diluent per dose; iii) instructions foradministering the compound of group i) and the diluent of group ii) to asubject in need thereof; and; iv) a container. In a further embodiment,the diluent is from about 1 to about 5 mL of a saline solution, asdescribed herein, per dose. In a further embodiment, the diluent is fromabout 1 to about 5 mL of a hypotonic saline solution per dose. Inanother embodiment, the diluent is from about 1 to about 5 mL of ahypertonic saline solution per dose. In a still further embodiment, thediluent is from about 1 to about 5 mL of sterile water per dose.

Also provided is a kit comprising i) a solution comprising apharmaceutically effective amount of a compound selected from those ofFormulas (A), (B), (C), (D), (E), (F), (G), (H), (I), (J), (K), (L),(M), (B-1), (B-2), (B-3), (B-4), (E-1), (E-2), (E-3), (E-4), (H-1),(H-2), (H-3), (H-4), (K-1), (K-2), (K-3), and (K-4), or apharmaceutically acceptable salt thereof; dissolved in apharmaceutically acceptable diluent; iii) instructions for administeringthe solution of group i) to a subject in need thereof; and iii) acontainer.

Also provided is a kit comprising i) a solution comprising from about 10ng to about 10 mg of a compound selected from those of Formulas (A),(B), (C), (D), (E), (F), (G), (H), (I), (J), (K), (L), (M), (B-1),(B-2), (B-3), (B-4), (E-1), (E-2), (E-3), (E-4), (H-1), (H-2), (H-3),(H-4), (K-1), (K-2), (K-3), and (K-4), or a pharmaceutically acceptablesalt thereof; dissolved in a pharmaceutically acceptable diluent; iii)instructions for administering the solution of group i) to a subject inneed thereof; and iii) a container. In a further embodiment, the diluentis from about 1 to about 5 mL of a saline solution, as described herein,per dose.

Another embodiment comprises a kit comprising i) a pharmaceuticallyeffective amount of a compound selected from those of Formulas (A), (B),(C), (D), (E), (F), (G), (H), (I), (J), (K), (L), (M), (B-1), (B-2),(B-3), (B-4), (E-1), (E-2), (E-3), (E-4), (H-1), (H-2), (H-3), (H-4),(K-1), (K-2), (K-3), and (K-4), or a pharmaceutically acceptable saltthereof; in a dry powder formulation suitable for inhalation ii)optionally, one or more pharmaceutically acceptable excipients orcarriers suitable for inhalation; iii) instructions for administeringthe compound of group i) and the excipients or carriers of group ii) toa subject in need thereof; and; iv) a container. In a furtherembodiment, the kit also comprises a dry powder inhaler suitable fordelivering the dry powder formulation to a recipient. The dry powderinhaler may be, in additional embodiments, a single-dose inhaler or amulti-dose inhaler.

Further embodiments of each of the kits described herein includes thosein which the concentration of the compound selected from those ofFormulas (A), (B), (C), (D), (E), (F), (G), (H), (I), (J), (K), (L),(M), (B-1), (B-2), (B-3), (B-4), (E-1), (E-2), (E-3), (E-4), (H-1),(H-2), (H-3), (H-4), (K-1), (K-2), (K-3), and (K-4), or apharmaceutically acceptable salt thereof, per dose, is one of theeffective dose ranges described herein, including a) from about 0.1 μgto about 1,000 μg; b) from about 0.5 μg to about 0.5 mg; and c) fromabout 0.5 μg to about 50 μg.

For each of the kits described above there is an additional embodimentin which the diluent is hypertonic saline of the concentrationsdescribed herein. In another embodiment for each kit the diluent ishypotonic saline of the concentrations described herein. In a furtherembodiment for each kit, the diluent is sterile water suitable forinhalation.

The pharmaceutically acceptable excipient(s), diluent(s) or carrier(s)must be acceptable in the sense of being compatible with the otheringredients of the formulation and not deleterious to the recipientthereof. Generally, the pharmaceutically acceptable excipient(s),diluent(s) or carrier(s) employed in the pharmaceutical formulation are“non-toxic” meaning that it/they is/are deemed safe for consumption inthe amount delivered in the formulation and “inert” meaning that it/theydoes/do not appreciable react with or result in an undesired effect onthe therapeutic activity of the active ingredient(s). Pharmaceuticallyacceptable excipients, diluents and carriers are conventional in the artand may be selected using conventional techniques, based upon thedesired route of administration. See, REMINGTON'S, PHARMACEUTICALSCIENCES, Lippincott Williams & Wilkins; 21^(st) Ed (May 1, 2005).Preferably, the pharmaceutically acceptable excipient(s), diluent(s) orcarrier(s) are Generally Regarded As Safe (GRAS) according to the FDA.

Pharmaceutical compositions according to the invention include thosesuitable for oral administration; parenteral administration, includingsubcutaneous, intradermal, intramuscular, intravenous andintraarticular; topical administration, including topical administrationto the skin, eyes, ears, etc; vaginal or rectal administration; andadministration to the respiratory tract, including the nasal cavitiesand sinuses, oral and extrathoracic airways, and the lungs, including byuse of aerosols which may be delivered by means of various types of drypowder inhalers, pressurized metered dose inhalers, softmist inhalers,nebulizers, or insufflators. The most suitable route of administrationmay depend upon, several factors including the patient and the conditionor disorder being treated.

The formulations may be presented in unit dosage form or in bulk form asfor example in the case of formulations to be metered by an inhaler andmay be prepared by any of the methods well known in the art of pharmacy.Generally, the methods include the step of bringing the activeingredient into association with the carrier, diluent or excipient andoptionally one or more accessory ingredients. In general theformulations are prepared by uniformly and intimately bringing intoassociation the active ingredient with one or more liquid carriers,diluents or excipients or finely divided solid carriers, diluents orexcipients, or both, and then, if necessary, shaping the product intothe desired formulation.

In one preferred embodiment, the composition is an inhalablepharmaceutical composition which is suitable for inhalation and deliveryto the endobronchial space. Typically, such composition is in the formof an aerosol comprising particles for delivery using a nebulizer,pressurized metered dose inhaler (MDI), softmist inhaler, or dry powderinhaler (DPI). The aerosol formulation used in the methods of thepresent invention may be a liquid (e.g., solution) suitable foradministration by a nebulizer, softmist inhaler, or MDI, or a dry powdersuitable for administration by an MDI or DPI.

Aerosols used to administer medicaments to the respiratory tract aretypically polydisperse; that is they are comprised of particles of manydifferent sizes. The particle size distribution is typically describedby the Mass Median Aerodynamic Diameter (MMAD) and the GeometricStandard Deviation (GSD). For optimum drug delivery to the endobronchialspace the MMAD is in the range from about 1 to about 10 urn andpreferably from about 1 to about 5 μm, and the GSD is less than 3, andpreferably less than about 2. Aerosols having a MMAD above 10 μm aregenerally too large when inhaled to reach the lungs. Aerosols with a GSDgreater than about 3 are not preferred for lung delivery as they delivera high percentage of the medicament to the oral cavity. To achieve theseparticle sizes in powder formulation, the particles of the activeingredient may be size reduced using conventional techniques such asmicronisation or spray drying. Non-limiting examples of other processesor techniques that can be used to produce respirable particles includespray drying, precipitation, supercritical fluid, and freeze drying. Thedesired fraction may be separated out by air classification or sieving.In one embodiment, the particles will be crystalline. For liquidformulations, the particle size is determined by the selection of aparticular model of nebulizer, softmist inhaler, or MDI.

Aerosol particle size distributions are determined using devices wellknown in the art. For example a multi-stage Anderson cascade impactor orother suitable method such as those specifically cited within the USPharmacopoeia Chapter 601 as characterizing devices for aerosols emittedfrom metered-dose and dry powder inhalers.

Dry powder compositions for topical delivery to the lung by inhalationmay be formulated without excipient or carrier and instead includingonly the active ingredients in a dry powder form having a suitableparticle size for inhalation. Dry powder compositions may also contain amix of the active ingredient and a suitable powder base(carrier/diluent/excipient substance) such as mono-, di- orpoly-saccharides (e.g., lactose or starch). Lactose is typically thepreferred excipient for dry powder formulations. When a solid excipientsuch as lactose is employed, generally the particle size of theexcipient will be much greater than the active ingredient to aid thedispersion of the formulation in the inhaler.

Non-limiting examples of dry powder inhalers include reservoirmulti-dose inhalers, pre-metered multi-dose inhalers, capsule-basedinhalers and single-dose disposable inhalers. A reservoir inhalercontains a large number of doses (e.g. 60) in one container. Prior toinhalation, the patient actuates the inhaler which causes the inhaler tometer one dose of medicament from the reservoir and prepare it forinhalation. Examples of reservoir DPIs include but are not limited tothe Turbohaler® by AstraZeneca and the ClickHaler® by Vectura.

In a pre-metered multi-dose inhaler, each individual dose has beenmanufactured in a separate container, and actuation of the inhaler priorto inhalation causes a new dose of drug to be released from itscontainer and prepared for inhalation. Examples of multidose DPIinhalers include but are not limited to Diskus® by GSK, Gyrohaler® byVectura, and Prohaler® by Valois. During inhalation, the inspiratoryflow of the patient accelerates the powder out of the device and intothe oral cavity. For a capsule inhaler, the formulation is in a capsuleand stored outside the inhaler. The patient puts a capsule in theinhaler, actuates the inhaler (punctures the capsule), then inhales.Examples include the Rotohaler™ (GlaxoSmithKline), Spinhaler™(Novartis), HandiHaler™ (IB), TurboSpin™ (PH&T). With single-dosedisposable inhalers, the patient actuates the inhaler to prepare it forinhalation, inhales, then disposes of the inhaler and packaging.Examples include the Twincer™ (U Groningen), OneDose™ (GFE), and MantaInhaler™ (Manta Devices).

Generally, dry powder inhalers utilize turbulent flow characteristics ofthe powder path to cause the excipient-drug aggregates to disperse, andthe particles of active ingredient are deposited in the lungs. However,certain dry powder inhalers utilize a cyclone dispersion chamber toproduce particles of the desired respirable size. In a cyclonedispersion chamber, the drug enters a coin shaped dispersion chambertangentially so that the air path and drug move along the outer circularwall. As the drug formulation moves along this circular wall it bouncesaround and agglomerates are broken apart by impact forces. The air pathspirals towards the center of the chamber exiting vertically. Particlesthat have small enough aerodynamic sizes can follow the air path andexit the chamber. In effect, the dispersion chamber works like a smalljet mill. Depending on the specifics of the formulation, large lactoseparticles may be added to the formulation to aid in the dispersionthrough impact with the API particles.

The Twincer™ single-dose disposable inhaler appears to operate using acoin-shaped cyclone dispersion chamber referred to as an “airclassifier.” See, U.S. Published Patent Application No. 2006/0237010 toRijksuniversiteit Groningen. Papers published by the University ofGroningen, have stated that a 60 mg dose of pure micronized colistinsulfomethate could be effectively delivered as an inhalable dry powderutilizing this technology.

In preferred embodiments, the aerosol formulation is delivered as a drypowder using a dry powder inhaler wherein the particles emitted from theinhaler have an MMAD in the range of about 1 μm to about 5 μm and a GSDabout less than 2.

Examples of suitable dry powder inhalers and dry powder dispersiondevices for use in the delivery of compounds and compositions accordingto the present invention include but are not limited to those disclosedin U.S. Pat. No. 7,520,278; U.S. Pat. No. 7,322,354; U.S. Pat. No.7,246,617; U.S. Pat. No. 7,231,920; U.S. Pat. No. 7,219,665; U.S. Pat.No. 7,207,330; U.S. Pat. No. 6,880,555; U.S. Pat. No. 5,522,385; U.S.Pat. No. 6,845,772; U.S. Pat. No. 6,637,431; U.S. Pat. No. 6,329,034;U.S. Pat. No. 5,458,135; U.S. Pat. No. 4,805,811; and U.S. PublishedPatent Application No. 2006/0237010.

In one embodiment, the pharmaceutical formulation according to theinvention is a dry powder for inhalation which is formulated fordelivery by a Diskus®-type device. The Diskus® device comprises anelongate strip formed from a base sheet having a plurality of recessesspaced along its length and a lid sheet hermetically but peelably sealedthereto to define a plurality of containers, each container havingtherein an inhalable formulation containing a predetermined amount ofactive ingredient either alone or in admixture with one or more carriersor excipients (e.g., lactose) and/or other therapeutically activeagents. Preferably, the strip is sufficiently flexible to be wound intoa roll. The lid sheet and base sheet will preferably have leading endportions which are not sealed to one another and at least one of theleading end portions is constructed to be attached to a winding means.Also, preferably the hermetic seal between the base and lid sheetsextends over their whole width. To prepare the dose for inhalation, thelid sheet may preferably be peeled from the base sheet in a longitudinaldirection from a first end of the base sheet.

In one embodiment, the pharmaceutical formulation according to theinvention is a dry powder for inhalation which is formulated fordelivery using a single-dose disposable inhaler, and particularly theTwincer™ inhaler. The Twincer™ inhaler comprises a foil laminate blisterwith one or more recesses and a lid sheet hermetically but peelablysealed thereto to define a plurality of containers. Each container hastherein an inhalable formulation containing a predetermined amount ofactive ingredient(s) either alone or in admixture with one or morecarriers or excipients (e.g., lactose). The lid sheet will preferablyhave a leading end portion which is constructed to project from the bodyof the inhaler. The patient would operate the device and therebyadminister the aerosol formulation by 1) removing the outer packagingoverwrap, 2) pulling the foil tab to uncover the drug in the blister and3) inhaling the drug from the blister.

In another embodiment, the pharmaceutical formulation according to theinvention is a dry powder for inhalation wherein the dry powder isformulated into microparticles as described in PCT Publication No.WO2009/015286 or WO2007/114881, both to NexBio. Such microparticles aregenerally formed by adding a counter ion to a solution containing acompound of the invention in a solvent, adding an antisolvent to thesolution; and gradually cooling the solution to a temperature belowabout 25° C., to form a composition containing microparticles comprisingthe compound. The microparticles comprising the compound may then beseparated from the solution by any suitable means such as sedimentation,filtration or lyophillization. Suitable counterions, solvents andantisolvents for preparing microparticles of the compounds of theinvention are described in WO2009/015286.

In another embodiment, a pharmaceutical composition according to theinvention is delivered as a dry powder using a metered dose inhaler.Non-limiting examples of metered dose inhalers and devices include thosedisclosed in U.S. Pat. No. 5,261,538; U.S. Pat. No. 5,544,647; U.S. Pat.No. 5,622,163; U.S. Pat. No. 4,955,371; U.S. Pat. No. 3,565,070; U.S.Pat. No. 3,361,306 and U.S. Pat. No. 6,116,234 and U.S. Pat. No.7,108,159. In a preferred embodiment, a compound of the invention isdelivered as a dry powder using a metered dose inhaler wherein theemitted particles have an MMAD that is in the range of about 1 μm toabout 5 μm and a GSD that is less than about 2.

Liquid aerosol formulations for delivery to the endobronchial space orlung by inhalation may for example be formulated as aqueous solutions orsuspensions or as aerosols delivered from pressurized packs, such asmetered dose inhalers, with the use of suitable liquefied propellants,softmist inhalers, or nebulizers. Such aerosol compositions suitable forinhalation can be either a suspension or a solution and generallycontain the active ingredient(s) together with a pharmaceuticallyacceptable carrier or diluent (e.g., water (distilled or sterile),saline, hypertonic saline, or ethanol) and optionally one or more othertherapeutically active agents.

Aerosol compositions for delivery by pressurized metered dose inhalerstypically further comprise a pharmaceutically acceptable propellant.Examples of such propellants include fluorocarbon or hydrogen-containingchlorofluorocarbon or mixtures thereof, particularly hydrofluoroalkanes,e.g., dichlorodifluoromethane, trichlorofluoromethane,dichlorotetrafluoroethane, especially 1,1,1,2-tetrafluoroethane,1,1,1,2,3,3,3,-heptafluoro-n-propane or a mixture thereof. The aerosolcomposition may be excipient free or may optionally contain additionalformulation excipients well known in the art such as surfactants e.g.,oleic acid or lecithin and cosolvents e.g., ethanol. Pressurizedformulations will generally be retained in a canister (e.g., an aluminumcanister) closed with a valve (e.g., a metering valve) and fitted intoan actuator provided with a mouthpiece.

In another embodiment, a pharmaceutical composition according to theinvention is delivered as a liquid using a metered dose inhaler.Non-limiting examples of metered dose inhalers and devices include thosedisclosed in U.S. Pat. Nos. 6,253,762, 6,413,497, 7,601,336, 7,481,995,6,743,413, and 7,105,152. In a preferred embodiment, a compound of theinvention is delivered as a dry powder using a metered dose inhalerwherein the emitted particles have an MMAD that is in the range of about1 μm to about 5 μm and a GSD that is less than about 2.

In one embodiment the aerosol formulation is suitable for aerosolizationby a jet nebulizer, or ultrasonic nebulizer including static andvibrating porous plate nebulizers. Liquid aerosol formulations fornebulization may be generated by solubilizing or reconstituting a solidparticle formulation or may be formulated with an aqueous vehicle withthe addition of agents such as acid or alkali, buffer salts, andisotonicity adjusting agents. They may be sterilized by in-processtechniques such as filtration, or terminal processes such as heating inan autoclave or gamma irradiation. They may also be presented innon-sterile form.

Patients can be sensitive to the pH, osmolality, and ionic content of anebulized solution. Therefore these parameters should be adjusted to becompatible with the active ingredient and tolerable to patients. Themost preferred solution or suspension of active ingredient will containa chloride concentration >30 mM at pH 4.5-7.4, preferably 5.0-5.5, andan osmolality of from about 800-1600 mOsm/kg. The pH of the solution canbe controlled by either titration with common acids (hydrochloric acidor sulfuric acid, for example) or bases (sodium hydroxide, for example)or via the use of buffers. Commonly used buffers include citratebuffers, such as citric acid/sodium citrate buffers, acetate buffers,such as acetic acid/sodium acetate buffers, and phosphate buffers.Buffer strengths can range from 2 mM to 50 mM.

Useful acetate, phosphate, and citrate buffers include sodium acetate,sodium acetate trihydrate, ammonium acetate, potassium acetate, sodiumphosphate, sodium phosphate dibasic, disodium hydrogen phosphate,potassium dihydrogen phosphate, potassium hydrogen phosphate, potassiumphosphate, sodium citrate, and potassium citrate. Other buffers whichmay be utilized include sodium hydroxide, potassium hydroxide, ammoniumhydroxide, aminomethylpropanol, tromethamine, tetrahydroxypropylethylenediamine, citric acid, acetic acid, hydroxytricarboxylic acid ora salt thereof, such as a citrate or sodium citrate salt thereof, lacticacid, and salts of lactic acid including sodium lactate, potassiumlactate, lithium lactate, calcium lactate, magnesium lactate, bariumlactate, aluminum lactate, zinc lactate, silver lactate, copper lactate,iron lactate, manganese lactate, ammonium lactate, monoethanolamine,diethanolamine, triethanolamine, diisopropanolamine, as well ascombinations thereof, and the like.

Such formulations may be administered using commercially availablenebulizers or other atomizer that can break the formulation intoparticles or droplets suitable for deposition in the respiratory tract.Non-limiting examples of nebulizers which may be employed for theaerosol delivery of a composition of the invention include pneumatic jetnebulizers, vented or breath-enhanced jet nebulizers, or ultrasonicnebulizers including static or vibrating porous plate nebulizers.Commercially available nebulizers include the Aeroneb® Go nebulizer(Aerogen) and the eFlow nebulizer (Pari Pharma).

A jet nebulizer utilizes a high velocity stream of air blasting upthrough a column of water to generate droplets. Particles unsuitable forinhalation impact on walls or aerodynamic baffles. A vented or breathenhanced nebulizer works in essentially the same way as a jet nebulizerexcept that inhaled air passes through the primary droplet generationarea to increase the output rate of the nebulizer while the patientinhales.

In an ultrasonic nebulizer, vibration of a piezoelectric crystal createssurface instabilities in the drug reservoir that cause droplets to beformed. In porous plate nebulizers pressure fields generated by sonicenergy force liquid through the mesh pores where it breaks into dropletsby Rayleigh breakup. The sonic energy may be supplied by a vibratinghorn or plate driven by a piezoelectric crystal, or by the mesh itselfvibrating. Non-limiting examples of atomizers include any single or twinfluid atomizer or nozzle that produces droplets of an appropriate size.A single fluid atomizer works by forcing a liquid through one or moreholes, where the jet of liquid breaks up into droplets. Twin fluidatomizers work by either forcing both a gas and liquid through one ormore holes, or by impinging a jet of liquid against another jet ofeither liquid or gas.

The choice of nebulizer which aerosolizes the aerosol formulation isimportant in the administration of the active ingredient(s). Differentnebulizers have differing efficiencies based their design and operationprinciple and are sensitive to the physical and chemical properties ofthe formulation. For example, two formulations with different surfacetensions may have different particle size distributions. Additionally,formulation properties such as pH, osmolality, and permeant ion contentcan affect tolerability of the medication, so preferred embodimentsconform to certain ranges of these properties.

In a preferred embodiment, the formulation for nebulization is deliveredto the endobronchial space as an aerosol having an MMAD between about 1μm□ and about 5 μm□ and a GSD less than 2 using an appropriatenebulizer. To be optimally effective and to avoid upper respiratory andsystemic side effects, the aerosol should not have a MMAD greater thanabout 5 μm and should not have a GSD greater than about 2. □□If anaerosol has an MMAD larger than about 5 μm or a GSD greater than about2□ a large percentage of the dose may be deposited in the upper airwaysdecreasing the amount of drug delivered to the desired site in the lowerrespiratory tract. If the MMAD of the aerosol is smaller than about 1μm□ then a large percentage of the particles may remain suspended in theinhaled air and may then be exhaled during expiration.

The compounds of the invention may also be administered bytransbronchoscopic lavage.

Formulations suitable for oral administration may be presented asdiscrete units such as capsules, cachets or tablets, each containing apredetermined amount of the active ingredient; as a powder or granules;as a solution or suspension in an aqueous liquid or a non-aqueousliquid; or as an oil-in-water liquid emulsion or a water-in-oil liquidemulsion. The active ingredient may also be presented as a sachet,bolus, electuary or paste.

A tablet may be made by compression or molding, optionally with one ormore accessory ingredients. Compressed tablets may be prepared bycompressing in a suitable machine the active ingredient in afree-flowing form such as a powder or granules, optionally mixed with abinders, lubricant, inert diluent, surface active or dispersing agent.Molded tablets may be made by molding in a suitable machine a mixture ofthe powdered compound moistened with an inert liquid diluent. Thetablets may optionally be coated or scored and may be formulated so asto provide slow or controlled release of the active ingredient therein.

Formulations for topical administration in the mouth, for examplebuccally or sublingually, include lozenges, comprising the activeingredient in a flavored base such as sucrose and acacia or tragacanth,and pastilles comprising the active ingredient in a base such as gelatinand glycerin or sucrose and acacia.

Formulations for parenteral administration include aqueous andnon-aqueous sterile injection solutions which may contain anti-oxidants,buffers, bacteriostats and solutes which render the formulation isotonicwith the blood of the intended recipient; and aqueous and non-aqueoussterile suspensions which may include suspending agents and thickeningagents. The formulations may be presented in unit-dose or multi-dosecontainers, for example sealed ampoules and vials, and may be stored ina freeze-dried (lyophilized) condition requiring only the addition ofthe sterile liquid carrier, for example saline or water-for-injection,immediately prior to use. Extemporaneous injection solutions andsuspensions may be prepared from sterile powders, granules and tabletsof the kind previously described.

Oral fluids such as solutions, syrups and elixirs can be prepared indosage unit form so that a given quantity contains a predeterminedamount of the active ingredient. Syrups can be prepared by dissolvingthe active ingredient in a suitably flavored aqueous solution, whileelixirs are prepared through the use of a pharmaceutically acceptablealcoholic vehicle. Suspensions can be formulated by dispersing theactive ingredient in a pharmaceutically acceptable vehicle. Solubilizersand emulsifiers such as ethoxylated isostearyl alcohols and polyoxyethylene sorbitol ethers, preservatives, flavor additive such aspeppermint oil or natural sweeteners or saccharin or other artificialsweeteners, and the like can also be incorporated into oral liquidcompositions.

Liposome delivery systems such as small unilamellar vesicles, largeunilamellar vesicles and multilamellar vesicles may also be employed asdelivery means for the compounds of the invention. Liposomes may beformed from a variety of phospholipids such as cholesterol, stearylamineand phosphatidylcholines.

Pharmaceutical compositions for topical administration may be formulatedas ointments, creams, suspensions, lotions, powders, solutions, pastes,gels, sprays, aerosols or oils. Compositions designed for the treatmentof the eyes or other external tissues, for example the mouth and skin,may be applied as a topical ointment or cream. When formulated as anointment, the active ingredient may be employed with either a paraffinicor a water-miscible ointment base. Alternatively, the active ingredientmay be formulated in a cream with an oil-in-water cream base or awater-in-oil base.

Other compositions designed for topical administration to the eyes orears include eye drops and ear drops wherein the active ingredient isdissolved or suspended in a suitable carrier, such as for example anaqueous solvent, including saline.

Compositions designed for nasal administration include aerosols,solutions, suspensions, sprays, mists and drops. Aerosolableformulations for nasal administration may be formulated in much the sameways as aerosolable formulations for inhalation with the condition thatparticles of non-respirable size will be preferred in formulations fornasal administration. Typically, particles of about 5 microns in size,up to the size of visible droplets may be employed. Thus, for nasaladministration, a particle size in the range of 10-500 μm may be used toensure retention in the nasal cavity.

Transdermal patches may also be employed, which are designed to remainin contact with the epidermis of the patient for an extended period oftime and promote the absorption of the active ingredient there through.

Compositions for vaginal or rectal administration include ointments,creams, suppositories and enemas, all of which may be formulated usingconventional techniques.

In another aspect, the invention provides a method of promotinghydration of mucosal surfaces or restoring mucosal defense in a human inneed thereof, comprising administering to the human a pharmaceuticalcomposition comprising a compound of the invention, wherein saidcompound is administered in an effective amount. In one preferredembodiment, the method comprises administering the pharmaceuticalcomposition as an inhalable composition comprising an amount of acompound of the invention that is sufficient to achieve dissolvedconcentration of the compound on the airway surfaces of from about 10⁻⁹,10⁻⁸, or 10⁻⁷ to about 10⁻⁴, 10⁻³, 10⁻², or 10⁻¹ Moles/liter, morepreferably from about 10⁻⁹ to about 10⁻⁴ Moles/liter.

In another aspect, the invention provides a method of treating any oneof: a disease associated with reversible or irreversible airwayobstruction, chronic obstructive pulmonary disease (COPD), asthma,bronchiectasis (including bronchiectasis due to conditions other thancystic fibrosis), acute bronchitis, chronic bronchitis, post-viralcough, cystic fibrosis, emphysema, pneumonia, panbronchiolitis,transplant-associate bronchiolitis, and ventilator-associatedtracheobronchitis or preventing ventilator-associated pneumonia in ahuman in need thereof, comprising administering to the human apharmaceutical composition comprising a compound of the invention,wherein said compound is administered in an effective amount. In onepreferred embodiment, the method comprises administering thepharmaceutical composition as an inhalable composition comprising anamount of a compound of the invention that is sufficient to achievedissolved concentration of the compound on the airway surfaces of fromabout 10⁻⁹, 10⁻⁹, or 10⁻⁷ to about 10⁻⁴, 10⁻³, 10⁻², or 10⁻¹Moles/liter, more preferably from about 10⁻⁹ to about 10⁻⁴ Moles/liter.

In another aspect, the invention provides a method of treating any oneof dry mouth (xerostomia), dry skin, vaginal dryness, sinusitis,rhinosinusitis, or nasal dehydration, including nasal dehydrationbrought on by administering dry oxygen, dry eye or Sjogren's disease,promoting ocular or corneal hydration, treating distal intestinalobstruction syndrome, treating otitis media, primary ciliary diskinesia,distal intestinal obstruction syndrome, esophagitis, constipation, orchronic diverticulitis in a human in need thereof, comprisingadministering to the human a pharmaceutical composition comprising acompound of the invention, wherein said compound is administered in aneffective amount.

Preferred unit dosage formulations for the compounds of the inventionare those containing an effective amount of the active ingredient or anappropriate fraction thereof.

It should be understood that in addition to the ingredients particularlymentioned above, the formulations of this invention may include otheragents conventional in the art having regard to the type of formulationin question for example those suitable for oral administration mayinclude flavoring agents.

The compositions of the present invention may be formulated forimmediate, controlled or sustained release as desired for the particularcondition being treated and the desired route of administration. Forexample, a controlled release formulation for oral administration may bedesired for the treatment of constipation in order to maximize deliveryof the active agent to colon. Such formulations and suitable excipientsfor the same are well known in the art of pharmacy. Because the freebase of the compound is generally less soluble in aqueous solutions thanthe salt, compositions comprising a free base of a compound of Formula(A) may be employed to provide more sustained release of active agentdelivered by inhalation to the lungs. An active agent present in thelungs in particulate form which has not dissolved into solution is notavailable to induce a physiological response, but serves as a depot ofbioavailable drug which gradually dissolves into solution. As anotherexample, a formulation may employ both a free base and salt form of acompound of the invention to provide both immediate release andsustained release of the active ingredient for dissolution into themucus secretions of, for example, the nose.

Combinations

The compounds of the invention may be formulated and/or used incombination with other therapeutically active agents. Examples of othertherapeutically active agents which may be formulated or used incombination with the compounds of the invention include but are notlimited to osmolytes, anti-inflammatory agents, anticholinergic agents,β-agonists (including selective β₂-agonists), P2Y2 receptor agonists,peroxisome proliferator-activated receptor (PPAR) delta agonists, otherepithelial sodium channel blockers (ENaC receptor blockers), cysticfibrosis transmembrane conductance regulator (CFTR) modulators, kinaseinhibitors, antiinfective agents, antihistamines, non-antibioticanti-inflammatory macrolides, elastase and protease inhibitors, andmucus or mucin modifying agents, such as surfactants. In addition, forcardiovascular indications, the compounds of the invention may be usedin combination with beta blockers, ACE inhibitors, HMGCoA reductaseinhibitors, calcium channel blockers and other cardiovascular agents.

The present invention thus provides, as another aspect, a compositioncomprising an effective amount of a compound of the invention and one ormore other therapeutically active agents selected from osmolytes,anti-inflammatory agents, anticholinergic agents, β-agonists (includingselective β₂-agonists), P2Y2 receptor agonists, PPAR delta agonists,ENaC receptor blockers, cystic fibrosis transmembrane conductanceregulator (CFTR) modulators, kinase inhibitors, antiinfective agents,antihistamines, non-antibiotic anti-inflammatory macrolides, elastaseand protease inhibitors, and mucus or mucin modifying agents, such assurfactants. The present invention thus provides, as another aspect, acomposition comprising an effective amount of a compound of theinvention and one or more other therapeutically active agents selectedfrom beta blockers, ACE inhibitors, HMGCoA reductase inhibitors, andcalcium channel blockers. Use of the compounds of the invention incombination with one or more other therapeutically active agents(particularly osmolytes) may lower the dose of the compound of theinvention that is required to sufficiently hydrate mucosal surfaces,thereby reducing the potential for undesired side-effects attributableto systemic blocking of sodium channels such as for example in thekidneys.

“Osmolytes” according to the present invention are molecules orcompounds that are osmotically active. “Osmotically active” moleculesand compounds are membrane-impermeable (i.e., essentiallynon-absorbable) on the airway or pulmonary epithelial surface. The terms“airway surface” and “pulmonary surface,” as used herein, includepulmonary airway surfaces such as the bronchi and bronchioles, alveolarsurfaces, and nasal and sinus surfaces. Suitable osmolytes include ionicosmolytes (i.e., salts), and non-ionic osmolytes (i.e., sugars, sugaralcohols, and organic osmolytes). In general, osmolytes (both ionic andnon-ionic) used in combination with the compounds of the invention arepreferably osmolytes that do not promote, or in fact deter or retardbacterial growth. Osmolytes suitable for use in the present inventionmay be in racemic form or in the form of an enantiomer, diastereomer,tautomer, polymorph or pseudopolymorph.

Examples of ionic osmolytes useful in the present invention include anysalt of a pharmaceutically acceptable anion and a pharmaceuticallyacceptable cation. Preferably, either (or both) of the anion and cationare osmotically active and not subject to rapid active transport, inrelation to the airway surfaces to which they are administered. Suchcompounds include but are not limited to anions and cations that arecontained in FDA approved commercially marketed salts, see, e.g.,Remington: The Science and Practice of Pharmacy, Vol. II, pg. 1457(19^(th) Ed. 1995), and can be used in any combination as known in theart.

Specific examples of pharmaceutically acceptable osmotically activeanions include but are not limited to, acetate, benzenesulfonate,benzoate, bicarbonate, bitartrate, bromide, calcium edetate, camsylate(camphorsulfonate), carbonate, chloride, citrate, dihydrochloride,edetate, edisylate (1,2-ethanedisulfonate), estolate (lauryl sulfate),esylate (1,2-ethanedisulfonate), fumarate, gluceptate, gluconate,glutamate, glycollylarsanilate (p-glycollamidophenylarsonate),hexylresorcinate, hydrabamine (N,N′-Di(dehydroabietyl)ethylenediamine),hydrobromide, hydrochloride, hydroxynaphthoate, iodide, isethionate,lactate, lactobionate, malate, maleate, mandelate, mesylate,methylbromide, methylnitrate, methylsulfate, mucate, napsylate, nitrate,nitrite, pamoate (embonate), pantothenate, phosphate or diphosphate,polygalacturonate, salicylate, stearate, subacetate, succinate, sulfate,tannate, tartrate, teoclate (8-chlorotheophyllinate), triethiodide,bicarbonate, etc. Preferred anions include chloride, sulfate, nitrate,gluconate, iodide, bicarbonate, bromide, and phosphate.

Specific examples of pharmaceutically acceptable osmotically activecations include but are not limited to, organic cations such asbenzathine (N,N′-dibenzylethylenediamine), chloroprocaine, choline,diethanolamine, ethylenediamine, meglumine (N-methyl D-glucamine),procaine, D-lysine, L-lysine, D-arginine, L-arginine, triethylammonium,N-methyl D-glycerol, and the like; and metallic cations such asaluminum, calcium, lithium, magnesium, potassium, sodium, zinc, iron,ammonium, and the like. Preferred organic cations include 3-carbon,4-carbon, 5-carbon and 6-carbon organic cations. Preferred cationsinclude sodium, potassium, choline, lithium, meglumine, D-lysine,ammonium, magnesium, and calcium.

Specific examples of ionic osmolytes that may be used in combinationwith a compound of the invention include but are not limited to, sodiumchloride (particularly hypertonic saline), potassium chloride, cholinechloride, choline iodide, lithium chloride, meglumine chloride, L-lysinechloride, D-lysine chloride, ammonium chloride, potassium sulfate,potassium nitrate, potassium gluconate, potassium iodide, ferricchloride, ferrous chloride, potassium bromide, and combinations of anytwo or more of the foregoing. In one embodiment, the present inventionprovides a combination of a compound of the invention and two differentosmotically active salts. When different salts are used, one of theanion or cation may be the same among the differing salts. Hypertonicsaline is a preferred ionic osmolyte for use in combination with thecompounds of the invention. Non-ionic osmolytes include sugars,sugar-alcohols, and organic osmolytes.

Sugars and sugar-alcohols useful as osmolytes in the present inventioninclude but are not limited to 3-carbon sugars (e.g., glycerol,dihydroxyacetone); 4-carbon sugars (e.g., both the D and L forms oferythrose, threose, and erythrulose); 5-carbon sugars (e.g., both the Dand L forms of ribose, arabinose, xylose, lyxose, psicose, fructose,sorbose, and tagatose); and 6-carbon sugars (e.g., both the D and Lforms of altose, allose, glucose, mannose, gulose, idose, galactose, andtalose, and the D and L forms of allo-heptulose, allo-hepulose,gluco-heptulose, manno-heptulose, gulo-heptulose, ido-heptulose,galacto-heptulose, talo-heptulose). Additional sugars useful in thepractice of the present invention include raffinose, raffinose seriesoligosaccharides, and stachyose. Both the D and L forms of the reducedform of each sugar/sugar alcohol are also suitable for the presentinvention. For example, glucose, when reduced, becomes sorbitol; anosmolyte within the scope of the invention. Accordingly, sorbitol andother reduced forms of sugar/sugar alcohols (e.g., mannitol, dulcitol,arabitol) are suitable osmolytes for use in the present invention.Mannitol is a preferred non-ionic osmolyte for use in combination withthe compounds of the invention.

“Organic osmolytes” is generally used to refer to molecules that controlintracellular osmolality in the kidney. See e.g., J. S. Handler et al.,Comp. Biochem. Physiol, 117, 301-306 (1997); M. Burg, Am. J. Physiol.268, F983-F996 (1995). Organic osmolytes include but are not limited tothree major classes of compounds: polyols (polyhydric alcohols),methylamines, and amino acids. Suitable polyol organic osmolytes includebut are not limited to, inositol, myo-inositol, and sorbitol. Suitablemethylamine organic osmolytes include but are not limited to, choline,betaine, carnitine (L-, D- and DL forms), phosphorylcholine,lyso-phosphorylcholine, glycerophosphorylcholine, creatine, and creatinephosphate. Suitable amino acid organic osmolytes include but are notlimited to, the D- and L-forms of glycine, alanine, glutamine,glutamate, aspartate, proline and taurine. Additional organic osmolytessuitable for use in the present invention include tihulose andsarcosine. Mammalian organic osmolytes are preferred, with human organicosmolytes being most preferred. However, certain organic osmolytes areof bacterial, yeast, and marine animal origin, and these compounds mayalso be employed in the present invention.

Osmolyte precursors may be used in combination with the compounds of theinvention An “osmolyte precursor” as used herein refers to a compoundwhich is converted into an osmolyte by a metabolic step, eithercatabolic or anabolic. Examples of osmolyte precursors include but arenot limited to, glucose, glucose polymers, glycerol, choline,phosphatidylcholine, lyso-phosphatidylcholine and inorganic phosphates,which are precursors of polyols and methylamines. Precursors of aminoacid osmolytes include proteins, peptides, and polyamino acids, whichare hydrolyzed to yield osmolyte amino acids, and metabolic precursorswhich can be converted into osmolyte amino acids by a metabolic stepsuch as transamination. For example, a precursor of the amino acidglutamine is poly-L-glutamine, and a precursor of glutamate ispoly-L-glutamic acid.

Chemically modified osmolytes or osmolyte precursors may also beemployed. Such chemical modifications involve linking the osmolyte (orprecursor) to an additional chemical group which alters or enhances theeffect of the osmolyte or osmolyte precursor (e.g., inhibits degradationof the osmolyte molecule). Such chemical modifications have beenutilized with drugs or prodrugs and are known in the art. (See, forexample, U.S. Pat. Nos. 4,479,932 and 4,540,564; Shek, E. et al., J.Med. Chem. 19:113-117 (1976); Bodor, N. et al., J. Pharm. Sci.67:1045-1050 (1978); Bodor, N. et al., J. Med. Chem. 26:313-318 (1983);Bodor, N. et al., J. Pharm. Sci. 75:29-35 (1986).

Preferred osmolytes for use in combination with the compounds of theinvention include sodium chloride, particular hypertonic saline, andmannitol.

For the formulation of 7% and >7% hypertonic saline, formulationscontaining bicarbonate anions may be particularly useful, especially forrespiratory disorders with cystic fibrosis transmembrane conductanceregulator (CFTR) dysfunction such as CF or COPD. Recent findingsindicate that, although the relative ratio of HCO₃ ⁻ conductance/Cl⁻conductance is between 0.1 and 0.2 for single CFTR channels activatedwith cAMP and ATP, the ratio in the sweat duct can range from virtually0 to almost 1.0, depending on conditions of stimulation. That is,combining cAMP+cGMP+α-ketoglutarate can yield CFTR HCO₃ ⁻ conductancealmost equal to that of Cl⁻ conductance (Quiton et al. Physiology, Vol.22, No. 3, 212-225, June 2007). Furthermore, formulations of 7% and >7%hypertonic saline containing bicarbonate anions may be particularlyuseful due to better control of the pH in the airway surface liquid.First, it has shown that that airway acidification occurs in CF (Tate etal. 2002) and that absent CFTR-dependent bicarbonate secretion can leadto an impaired capacity to respond to airway conditions associated withacidification of airway surface liquid layer (Coakley et al. 2003).Second, addition of HS solution without bicarbonate to the surface ofthe lung may further dilute the bicarbonate concentrations, andpotentially reduce the pH or the ability to respond to airwayacidification within the airway surface liquid layer. Therefore additionof bicarbonate anions to HS may help maintain or improve the pH ofairway surface liquid layer in CF patients.

Due to this evidence, inclusion of bicarbonate anion in the formulationof 7% or >7% hypertonic saline administered by the method of thisinvention would be particularly useful. Formulations containing up to 30to 200 mM concentrations of bicarbonate anions are of particularinterest for 7% or >7% HS solutions.

Hypertonic saline is understood to have a salt concentration greaterthan that of normal saline (NS), i.e. greater than 9 g/L or 0.9% w/v,and hypotonic saline has a salt concentration less than that of normalsaline, such as from about 1 g/L or 0.1% w/v to about 8 g/L or 0.8% w/v.Hypertonic saline solutions useful in the formulations and methods oftreatment herein may have a salt concentration from about 1% to about23.4% (w/v). In one embodiment the hypertonic saline solution has a saltconcentration from about 60 g/L (6% w/v) to about 100 g/L (10% w/v). Inanother embodiment, the saline solution has a salt concentration fromabout 70 g/L (7% w/v) to about 100 g/L (10% w/v). In furtherembodiments, the saline solution has salt concentrations of a) fromabout 0.5 g/L (0.05% w/v) to about 70 g/L (7% w/v); b) from about 1 g/L(0.1% w/v) to about 60 g/L (6% w/v); c) from about 1 g/L (0.1% w/v) toabout 50 g/L (5% w/v); d) from about 1 g/L (0.1% w/v) to about 40 g/L(4% w/v); e) from about 1 g/L (0.1% w/v) to about 30 g/L (3% w/v); andf) from about 1 g/L (0.1% w/v) to about 20 g/L (2% w/v).

Specific concentrations of saline solutions useful in the formulationsand methods of treatment herein include, independently, those havingsalt concentrations of 1 g/L (0.1% w/v), 2 g/L (0.2% w/v), 3 g/L (0.3%w/v), 4 g/L (0.4% w/v), 5 g/L (0.5% w/v), 6 g/L (0.6% w/v), 7 g/L (0.7%w/v), 8 g/L (0.8% w/v), 9 g/L (0.9% w/v), 10 g/L (1% w/v), 20 g/L (2%w/v), 30 g/L (3% w/v), 40 g/L (4% w/v), 50 g/L (5% w/v), 60 g/L (6%w/v), 70 g/L (7% w/v), 80 g/L (8% w/v), 90 g/L (9% w/v), 100 g/L (10%w/v), 110 g/L (11% w/v), 120 g/L (12% w/v), 130 g/L (13% w/v), 140 g/L(14% w/v), 150 g/L (15% w/v), 160 g/L (16% w/v), 170 g/L (17% w/v), 180g/L (18% w/v), 190 g/L (19% w/v), 200 g/L (20% w/v), 210 g/L (21% w/v),220 g/L (22% w/v), and 230 g/L (23% w/v). Saline concentrations betweeneach of these listed concentrations/percentages may also be used, suchas saline of 1.7 g/L (0.17% w/v), 1.25 g/L (1.25% w/v), 1.5 g/L (1.5%w/v), 25 g/L (2.5% w/v), 28 g/L (2.8% w/v), 35 g/L (3.5% w/v), 45 g/L(4.5% w/v), and 75 g/L (7.5% w/v).

Specific useful concentration of hypotonic saline solutions includethose from about 0.12 g/L (0.012% w/v) to about 8.5 g/L (0.85% w/v). Anyconcentration within this range may be used, such as, on a w/v basis,0.05%, 0.1%, 0.15%, 0.2%, 0.225% (¼ NS), 0.25%, 0.3% (⅓ NS), 0.35%,0.4%, 0.45% (½ NS), 0.5%, 0.55%, 0.6% (⅔ NS), 0.65%, 0.675% (¾ NS),0.7%, 0.75%, and 0.8%.

Each of the ranges and specific concentrations of saline describedherein may be used with the formulations, methods of treatment,regimens, and kits described herein.

Also intended within the scope of this invention are chemically modifiedosmolytes or osmolyte precursors. Such chemical modifications involvelinking to the osmolyte (or precursor) an additional chemical groupwhich alters or enhances the effect of the osmolyte or osmolyteprecursor (e.g., inhibits degradation of the osmolyte molecule). Suchchemical modifications have been utilized with drugs or prodrugs and areknown in the art. (See, for example, U.S. Pat. Nos. 4,479,932 and4,540,564; Shek, E. et al., J. Med. Chem. 19:113-117 (1976); Bodor, N.et al., J. Pharm. Sci. 67:1045-1050 (1978); Bodor, N. et al., J. Med.Chem. 26:313-318 (1983); Bodor, N. et al., J. Pharm. Sci. 75:29-35(1986), each incorporated herein by reference.

Suitable anti-inflammatory agents for use in combination with thecompounds of the invention include corticosteroids and non-steroidalanti-inflammatory drugs (NSAIDs), particularly phosphodiesterase (PDE)inhibitors. Examples of corticosteroids for use in the present inventioninclude oral or inhaled corticosteroids or prodrugs thereof. Specificexamples include but are not limited to ciclesonide,desisobutyryl-ciclesonide, budesonide, flunisolide, mometasone andesters thereof (e.g., mometasone furoate), fluticasone propionate,fluticasone furoate, beclomethasone, methyl prednisolone, prednisolone,dexamethasone,6α,9α-difluoro-17α-[(2-furanylcarbonyl)oxy]-11β-hydroxy-16α-methyl-3-oxo-androsta-1,4-diene-17β-carbothioicacid S-fluoromethyl ester,6α,9α-difluoro-11β-hydroxy-16α-methyl-3-oxo-17α-propionyloxy-androsta-1,4-diene-17β-carbothioicacid S-(2-oxo-tetrahydro-furan-3S-yl) ester, beclomethasone esters(e.g., the 17-propionate ester or the 17,21-dipropionate ester,fluoromethyl ester, triamcinolone acetonide, rofleponide, or anycombination or subset thereof. Preferred corticosteroids for formulationor use in combination with the compounds of the invention are selectedfrom ciclesonide, desisobutyryl-ciclesonide, budesonide, mometasone,fluticasone propionate, and fluticasone furoate, or any combination orsubset thereof.

NSAIDs for use in the present invention include but are not limited tosodium cromoglycate, nedocromil sodium, phosphodiesterase (PDE)inhibitors (e.g., theophylline, aminophylline, PDE4 inhibitors, mixedPDE3/PDE4 inhibitors or mixed PDE4/PDE7 inhibitors), leukotrieneantagonists, inhibitors of leukotriene synthesis (e.g., 5 LO and FLAPinhibitors), inducible nitric oxide synthase (iNOS) inhibitors, proteaseinhibitors (e.g., tryptase inhibitors, neutrophil elastase inhibitors,and metalloprotease inhibitors) β2-integrin antagonists and adenosinereceptor agonists or antagonists (e.g., adenosine 2a agonists), cytokineantagonists (e.g., chemokine antagonists) or inhibitors of cytokinesynthesis (e.g., prostaglandin D2 (CRTh2) receptor antagonists).Examples of leukotriene modifiers suitable for administration by themethod of this invention include montelukast, zileuton, panlukast, andzafirlukast.

The PDE4 inhibitor, mixed PDE3/PDE4 inhibitor or mixed PDE4/PDE7inhibitor may be any compound that is known to inhibit the PDE4 enzymeor which is discovered to act as a PDE4 inhibitor, and which areselective PDE4 inhibitors (i.e., compounds which do not appreciablyinhibit other members of the PDE family). Examples of specific PDE4inhibitors for formulation and use in combination with the compounds ofthe present invention include but are not limited to roflumilast,pumafentrine, arofylline, cilomilast, tofimilast, oglemilast,tolafentrine, piclamilast, ibudilast, apremilast,2-[4-[6,7-diethoxy-2,3-bis(hydroxymethyl)-1-naphthalenyl]-2-pyridinyl]-4-(3-pyridinyl)-1(2H)-phthalazinone(T2585),N-(3,5-dichloro-4-pyridinyl)-1-[(4-fluorophenyl)methyl]-5-hydroxy-α-oxo-1H-indole-3-acetamide(AWD-12-281,4-[(2R)-2-[3-(cyclopentyloxy)-4-methoxyphenyl]-2-phenylethyl]-pyridine(CDP-840),2-[4-[[[[2-(1,3-benzodioxol-5-yloxy)-3-pyridinyl]carbonyl]amino]methyl]-3-fluorophenoxy]-(2R)-propanoicacid (CP-671305),N-(4,6-dimethyl-2-pyrimidinyl)-4-[4,5,6,7-tetrahydro-2-(4-methoxy-3-methylphenyl)-5-(4-methyl-1-piperazinyl)-1H-indol-1-yl]-benzenesulfonamide,(2E)-2-butenedioate (YM-393059),9-[(2-fluorophenyl)methyl]-N-methyl-2-(trifluoromethyl)-9H-purin-6-amine(NCS-613), N-(2,5-dichloro-3-pyridinyl)-8-methoxy-5-quinolinecarboxamide(D-4418),N-[(3R)-9-amino-3,4,6,7-tetrahydro-4-oxo-1-phenylpyrrolo[3,2,1-][1,4]benzodiazepin-3-yl]-3H-purin-6-amine(PD-168787),3-[[3-(cyclopentyloxy)-4-methoxyphenyl]methyl]-N-ethyl-8-(1-methylethyl)-3H-purin-6-aminehydrochloride (V-11294A),N-(3,5-dichloro-1-oxido-4-pyridinyl)-8-methoxy-2-(trifluoromethyl)-5-quinolinecarboxamide(Sch351591),5-[3-(cyclopentyloxy)-4-methoxyphenyl]-3-[(3-methylphenyl)methyl]-(3S,5S)-2-piperidinoneHT-0712),5-(2-((1R,4R)-4-amino-1-(3-(cyclopentyloxy)-4-methyoxyphenyl)cyclohexyl)ethynyl)-pyrimidine-2-amine,cis-[4-cyano-4-(3-cyclopropylmethoxy-4-difluoromethoxyphenyl)cyclohexan-1-ol], and4-[6,7-diethoxy-2,3-bis(hydroxymethyl)-1-naphthalenyl]-1-(2-methoxyethyl)-2(1H)-pyridinone(T-440),6-({3-[(Dimethylamino)carbonyl]phenyl}sulfonyl)-8-methyl-4-{[3-methyloxy)phenyl]amino}-3-quinolinecarboxamide(GSK256066), and any combination or subset thereof.

Anticholinergic agents for formulation or use in combination with thecompounds of the invention include but are not limited to muscarinicreceptor antagonists, particularly including pan antagonists andantagonists of the M₃ receptors. Exemplary compounds include thealkaloids of the belladonna plants, such as atropine, scopolamine,homatropine, hyoscyamine, and the various forms including salts thereof(e.g., anhydrous atropine, atropine sulfate, atropine oxide or HCl,methylatropine nitrate, homatropine hydrobromide, homatropine methylbromide, hyoscyamine hydrobromide, hyoscyamine sulfate, scopolaminehydrobromide, scopolamine methyl bromide), or any combination or subsetthereof.

Additional anticholinergics for formulation and use in combination withthe methantheline, propantheline bromide, anisotropine methyl bromide orValpin 50, aclidinium bromide, glycopyrrolate (Robinul), isopropamideiodide, mepenzolate bromide, tridihexethyl chloride, hexocycliummethylsulfate, cyclopentolate HCl, tropicamide, trihexyphenidyl CCl,pirenzepine, telenzepine, and methoctramine, or any combination orsubset thereof.

Preferred anticholinergics for formulation and use in combination withthe compounds of the invention include ipratropium (bromide), oxitropium(bromide) and tiotropium (bromide), aclidinium (bromide), or anycombination or subset thereof.

Examples of β-agonists for formulation and use in combination with thecompounds of the invention include but are not limited to salmeterol,R-salmeterol, and xinafoate salts thereof, albuterol (also known assalbutamol) or R-albuterol (free base or sulfate), levalbuterol,formoterol (fumarate), fenoterol, procaterol, pirbuterol, metaprterenol,terbutaline and salts thereof, and any combination or subset thereof.

P2Y₂ receptor agonists for formulation and use in combination with thecompounds of the invention may be employed in an amount effective tostimulate chloride and water secretion by airway surfaces, particularlynasal airway surfaces. Suitable P2Y₂ receptor agonists are known in theart and are described for example, in columns 9-10 of U.S. Pat. No.6,264,975, and also U.S. Pat. Nos. 5,656,256 and 5,292,498.

P2Y₂ agonists that can be administered by the methods of this inventioninclude P2Y₂ receptor agonists such as ATP, UTP, UTP-.gamma.-S anddinucleotide P2Y₂ receptor agonists (e.g. denufosol or diquafosol) or apharmaceutically acceptable salt thereof. The P2Y₂ receptor agonist istypically included in an amount effective to stimulate chloride andwater secretion by airway surfaces, particularly nasal airway surfaces.Suitable P2Y₂ receptor agonists are described in, but are not limitedto, U.S. Pat. No. 6,264,975, U.S. Pat. No. 5,656,256, U.S. Pat. No.5,292,498, U.S. Pat. No. 6,348,589, U.S. Pat. No. 6,818,629, U.S. Pat.No. 6,977,246, U.S. Pat. No. 7,223,744, U.S. Pat. No. 7,531,525 and U.S.Pat. AP. 2009/0306009 each of which is incorporated herein by reference.

Combination therapies and formulations herein can include adenosine 2b(A2b) agonists, also, including2-[6-amino-3,5-dicyano-4-[4-(cyclopropylmethoxy)phenyl]pyridin-2-ylsulfanyl]acetamide (BAY 60-6583), NECA(N-ethylcarboxamidoadenosine), (S)-PHPNECA, LUF-5835 and LUF-5845. A2bagonists that may be used are described by Volpini et al., Journal ofMedicinal Chemistry 45 (15): 3271-9 (2002); Volpini et al., CurrentPharmaceutical Design 8 (26): 2285-98 (2002); Baraldi et al., Journal ofMedicinal Chemistry 47 (6): Cacciari et al., 1434-47 (2004); MiniReviews in Medicinal Chemistry 5 (12): 1053-60 (December 2005); Baraldiet al., Current Medicinal Chemistry 13 (28): 3467-82 (2006); Beukers etal., Medicinal Research Reviews 26 (5): 667-98 (September 2006); Elzeinet al., Bioorganic & Medicinal Chemistry Letters 16 (2): 302-6 (January2006); Carotti, et al., Journal of Medicinal Chemistry 49 (1): 282-99(January 2006); Tabrizi et al., Bioorganic & Medicinal Chemistry 16 (5):2419-30 (March 2008); and Stefanachi, et al., Bioorganic & MedicinalChemistry 16 (6): 2852-69 (March 2008).

Examples of other ENaC receptor blockers for formulation and use incombination with the compounds of the invention include but are notlimited to amiloride and derivatives thereof such as those compoundsdescribed in U.S. Pat. No. 6,858,615, and PCT Publication Nos.WO2003/070182, WO2004/073629, WO2005/018644, WO2006/022935,WO2007/018640, and WO2007/146869.

Small molecule ENaC blockers are capable of directly preventing sodiumtransport through the ENaC channel pore. ENaC blocker that can beadministered in the combinations herein include, but are not limited to,amiloride, benzamil, phenamil, and amiloride analogues as exemplified byU.S. Pat. No. 6,858,614, U.S. Pat. No. 6,858,615, U.S. Pat. No.6,903,105, U.S. Pat. No. 6,995,160, U.S. Pat. No. 7,026,325, U.S. Pat.No. 7,030,117, U.S. Pat. No. 7,064,129, U.S. Pat. No. 7,186,833, U.S.Pat. No. 7,189,719, U.S. Pat. No. 7,192,958, U.S. Pat. No. 7,192,959,U.S. Pat. No. 7,241,766, U.S. Pat. No. 7,247,636, U.S. Pat. No.7,247,637, U.S. Pat. No. 7,317,013, U.S. Pat. No. 7,332,496, U.S. Pat.No. 7,345,044, U.S. Pat. No. 7,368,447, U.S. Pat. No. 7,368,450, U.S.Pat. No. 7,368,451, U.S. Pat. No. 7,375,107, U.S. Pat. No. 7,399,766,U.S. Pat. No. 7,410,968, U.S. Pat. No. 7,820,678, U.S. Pat. No.7,842,697, U.S. Pat. No. 7,868,010, U.S. Pat. No. 7,875,619.

ENaC proteolysis is well described to increase sodium transport throughENaC. Protease inhibitors block the activity of endogenous airwayproteases, thereby preventing ENaC cleavage and activation. Proteasesthat cleave ENaC include furin, meprin, matriptase, trypsin, channelassociated proteases (CAPs), and neutrophil elastases. Proteaseinhibitors that can inhibit the proteolytic activity of these proteasesthat can be administered in the combinations herein include, but are notlimited to, camostat, prostasin, furin, aprotinin, leupeptin, andtrypsin inhibitors.

Combinations herein may include one or more suitable nucleic acids (orpolynucleic acid), including but not limited to antisenseoligonucleotide, siRNA, miRNA, miRNA mimic, antagomir, ribozyme,aptamer, and decoy oligonucleotide nucleic acids. See, e.g., US PatentApplication Publication No. 20100316628. In general, such nucleic acidsmay be from 17 or 19 nucleotides in length, up to 23, 25 or 27nucleotides in length, or more. Examples include, but are not limitedto, those described in U.S. Pat. No. 7,517,865 and US PatentApplications Nos. 20100215588; 20100316628; 20110008366; and20110104255. In general, the siRNAs are from 17 or 19 nucleotides inlength, up to 23, 25 or 27 nucleotides in length, or more.

CFTR activity modulating compounds that can be administered in thecombinations of this invention include, but are not limited to,compounds described in US 2009/0246137 A1, US 2009/0253736 A1, US2010/0227888 A1, U.S. Pat. No. 7,645,789, US 2009/0246820 A1, US2009/0221597 A1, US 2010/0184739 A1, US 2010/0130547 A1, US 2010/0168094A1 and issued patent: U.S. Pat. No. 7,553,855; U.S. Pat. No. 7,772,259B2, U.S. Pat. No. 7,405,233 B2, US 2009/0203752, U.S. Pat. No.7,499,570, as well as Kalydeco™ (ivacaftor).

Mucus or mucin modifying agents useful in the combinations and methodsherein include reducing agents, surfactants and detergents,expectorants, and deoxyribonuclease agents.

Mucin proteins are organized into high molecular weight polymers via theformation of covalent (disulfide) and non-covalent bonds. Disruption ofthe covalent bonds with reducing agents is a well-established method toreduce the viscoelastic properties of mucus in vitro and is predicted tominimize mucus adhesiveness and improve clearance in vivo. Reducingagents are known to decrease mucus viscosity in vitro and commonly usedas an aid to processing sputum samples. Examples of reducing agentsinclude sulfide containing molecules or phosphines capable of reducingprotein di-sulfide bonds including, but not limited to, N-acetylcysteine, N-acystelyn, carbocysteine, glutathione, dithiothreitol,thioredoxin containing proteins, and tris (2-carboxyethyl) phosphine.

N-acetyl cysteine (NAC) is approved for use in conjunction with chestphysiotherapy to loosen viscid or thickened airway mucus. Clinicalstudies evaluating the effects of oral or inhaled NAC in CF and COPDhave reported improvements in the rheologic properties of mucus andtrends toward improvements in lung function and decreases in pulmonaryexacerbations. However, the preponderance of clinical data suggests thatNAC is at best a marginally effective therapeutic agent for treatingairway mucus obstruction when administered orally or by inhalation. Arecent Cochrane review of the existing clinical literature on the use ofNAC found no evidence to support the efficacy of NAC for CF.

NAC is a relative inefficient reducing agent which is only partiallyactive on the airway surface. Very high concentrations of NAC (200 mM or3.26%) are required to fully reduce Muc5B, a major gel-forming airwaymucin, in vitro. Furthermore, in the pH environment of the airwaysurface (measured in the range of pH 6.0 to 7.2 in CF and COPD airways),NAC exists only partially in its reactive state as a negatively chargethiolate. Thus, in the clinic, NAC is administered at very highconcentrations. However, it is predicted that current aerosol deviceswill not be able to achieve therapeutic concentrations of even a 20%Mucomyst solution on distal airway surfaces within the relatively shorttime domains (7.5-15 minutes) typically used.

In non-clinical studies, ¹⁴C-tabled NAC, administered by inhalation,exhibits rapid elimination from the lungs with a half-life ranging from6 to 36 minutes¹²

NAC is administered as a highly concentrated, hypertonic inhalationsolution (20% or 1.22 molar) and has been reported to causebronchoconstriction and cough. In many cases, it is recommended that NACbe administered with a bronchodilator to improve the tolerability ofthis agent.

Thus, reducing agents such as NAC are not well suited for bolus aerosoladministration. However, it is anticipated that delivery of reducingagents by pulmonary aerosol infusion would increase the effectiveness,while allowing for a decrease in the concentration of reducing agent inthe inhalation solution (predicted to increase tolerability).

Surfactants and detergents are spreading agents shown to decrease mucusviscoelasticity, improving mucus clearability. Examples of surfactantsinclude dipalmitoylphosphatidylcholine (DPPC), PF, palmitic acid,palmitoyl-oleoylphosphatidylglycerol, surfactant-associated proteins(e.g. SP-A, B, or C), or may be animal derived (e.g. from cow or calflung lavage or extracted from minced pig lung) or combinations thereof.See, e.g., U.S. Pat. Nos. 7,897,577; 5,876,970; 5,614,216; 5,100,806;and 4,312,860. Examples of surfactant products include Exosurf® Neonatal(colfosceril palmitate), Pumactant® (DPPC and egg phosphatidylglycerol),KL-4 surfactant, Venticute® (lusulptide, rSP-C surfactant), Alveofact®(bovactant), Curosurf® (poractant alfa), Infasurf® (calfactant),Newfacten® (modified bovine surfactant), Surface®, Netsurf™ (nonionicalcohol ethoxylate surfactant) and Survanta® (beractant). Examples ofdetergents include, but are not limited to, Tween-80 and triton-X 100.

Any suitable expectorant can be used, including but not limited toguaifenesin (see, e.g., U.S. Pat. No. 7,345,051). Any suitabledeoxyribonuclease can be used, including but not limited to DornaseAlpha. (see, e.g., U.S. Pat. No. 7,482,024). Examples of kinaseinhibitors include inhibitors of NFkB, PI3K (phosphatidylinositol3-kinase), p38-MAP kinase and Rho kinase.

Antiinfective agents for formulation and use in combination with thecompounds of the invention include antivirals and antibiotics. Examplesof suitable antivirals include Tamiflu® (oseltamivir) and Relenza®(zanamivir). Examples of suitable antibiotics include but are notlimited to aztreonam (arginine or lysine), fosfomycin, andaminoglycosides such as tobramycin, or any combination or subsetthereof. Additional anti-infective agents that may be used hereininclude aminoglycosides, Daptomycin, Fluoroquinolones, Ketolides,Carbapenems, Cephalosporins, Erythromycin, Linezolid, Penicillins,Azithromycin, Clindamycin, Oxazolidinones, Tetracyclines, andVancomycin.

Examples of useful carbapenam antibiotics are impenam, panipenam,meropenam, biapenam, MK-826 (L-749,345), DA-1131, ER-35786, lenapenam,S-4661, CS-834 (prodrug of R-95867), KR-21056 (prodrug of KR-21012),L-084 (prodrug of LJC 11036) and Ceftolozane (CXA-101).

Antihistamines (i.e., H1-receptor antagonists) for formulation and usein combination with the compounds of the invention include but are notlimited to: ethanolamines such as diphenhydramine HCl, carbinoxaminemaleate, doxylamine, clemastine fumarate, and dimenhydrinate;ethylenediamines such as pyrilamine maleate (metpyramine),tripelennamine HCl, tripelennamine citrate, and antazoline; alkylaminessuch as pheniramine, chioropheniramine, bromopheniramine,dexchlorpheniramine, triprolidine and acrivastine; pyridines such asmethapyrilene, piperazines such as hydroxyzine HCl, hydroxyzine pamoate,cyclizine HCl, cyclizine lactate, meclizine HCl and cetirizine HCl;piperidines such as astemisole, levocabastine HCl, loratadine,descarboethoxyloratadine, terfenadine, and fexofenadine HCl; tri- andtetracyclics such as promethazine, chlorpromethazine trimeprazine andazatadine; and azelastine HCl, or any combination or subset thereof.

Examples of other classes of therapeutic agents suitable for use in thecombinations and methods herein include antivirals such as ribavirin,anti-fungal agents such as amphotericin, intraconazole and voriconazole,anti-rejection drugs such as cyclosporine, tacrolimus and sirolimus,bronchodilators including but not limited to anticholinergic agents suchas atrovent, siRNAs, gene therapy vectors, aptamers, endothelin-receptorantagonists, alpha-1-antitrypsin and prostacyclins.

In the above-described methods of treatment and uses, a compound of theinvention may be employed alone, or in combination with one or moreother therapeutically active agents. Typically, any therapeuticallyactive agent that has a therapeutic effect in the disease or conditionbeing treated with the compound of the invention may be utilized incombination with the compounds of the invention, provided that theparticular therapeutically active agent is compatible with therapyemploying a compound of the invention. Typical therapeutically activeagents which are suitable for use in combination with the compounds ofthe invention include agents described above.

In one preferred embodiment, the compounds of the invention are used incombination with one or more osmolytes, particularly hypertonic salineor mannitol.

In another aspect, the invention provides methods for treatment and usesas described above, which comprise administering an effective amount ofa compound of the invention and at least one other therapeuticallyactive agent. The compounds of the invention and at least one additionaltherapeutically active agent may be employed in combinationconcomitantly or sequentially in any therapeutically appropriatecombination. The administration of a compound of the invention with oneor more other therapeutically active agents may be by administrationconcomitantly in 1) a unitary pharmaceutical composition, such as thecompositions described above, or 2) separate pharmaceutical compositionseach including one or more of the component active ingredients. Thecomponents of the combination may be administered separately in asequential manner wherein the compound of the invention is administeredfirst and the other therapeutically active agent is administered secondor vice versa.

In the embodiments wherein the compound of the invention is administeredin combination with one or more osmolytes, the administration of eachcomponent is preferably concomitant, and may be in a unitary compositionor separate compositions. In one embodiment, the compound of theinvention and one or more osmolytes are administered concomitantly bytransbronchoscopic lavage. In another embodiment, the compound of theinvention and one or more osmolytes are administered concomitantly byinhalation.

When a compound of the invention is used in combination with anothertherapeutically active agent, the dose of each compound may differ fromthat when the compound of the invention is used alone. Appropriate doseswill be readily determined by one of ordinary skill in the art. Theappropriate dose of the compound of the invention, the othertherapeutically active agent(s) and the relative timings ofadministration will be selected in order to achieve the desired combinedtherapeutic effect, and are within the expertise and discretion of theattendant physician, clinician or veterinarian.

Experimental Procedures

The present invention also provides processes for preparing thecompounds of the invention and to the synthetic intermediates useful insuch processes, as described in detail below.

Certain abbreviations and acronyms are used in describing the syntheticprocesses and experimental details. Although most of these would beunderstood by one skilled in the art, the following table contains alist of many of these abbreviations and acronyms.

ABBREVIATION MEANING

-   -   AcOH Acetic Acid    -   AIBN Azobisisobutyronitrile    -   DIAD Diisopropyl azidodicarboxylate    -   DIPEA N,N-Diisopropylethylamine    -   Cbz carboxybenzyl    -   DCE dichloroethane    -   DCM dichloromethane    -   DMF dimethylformamide    -   DMSO dimethylsulfoxide    -   Et Ethyl    -   EtOAc or EA ethyl acetate    -   EtOH Ethanol    -   ESI electrospray ionization    -   HATU 2-(1H-7-Azabenzotriazol-1-yl)-1,1,3,3-tetramethyluronium        hexafluorophosphate    -   HPLC High performance liquid chromatography    -   iCBF Isobutyl chloroformate    -   iPrOH Isopropyl alcohol    -   i.t. or IT intratracheal    -   Me Methyl    -   MeOH methanol    -   m/z or m/e mass to charge ratio    -   MH⁺ mass plus 1    -   MH⁻ mass minus 1    -   MIC minimal inhibitory concentration    -   MS or ms mass spectrum    -   MTBE methyl t-butyl ether    -   NaCNBH3 sodium cyanoborohydride    -   NMM N-methyl morpholine    -   rt or r.t. room temperature    -   R_(f) Retardation factor    -   t-Bu tert-butyl    -   TEA triethylamine    -   THF tetrahydrofuran    -   TLC or tlc thin layer chromatography    -   δ parts per million down field from tetramethylsilane    -   Cbz Benzyloxycarbonyl, i.e. —(CO)O-benzyl    -   AUC Area under the curve or peak    -   t_(R) Retention time    -   GC-MS Gas chromatography-mass spectrometry    -   wt % Percent by weight    -   h Hours    -   min Minutes    -   MHz megahertz    -   TFA Trifluoroacetic acid    -   UV Ultraviolet    -   Boc tert-butyloxycarbonyl    -   Ph₃P Triphenylphosphine        The compounds of Formula (A) may be synthesized using techniques        known in the art. A representative synthetic procedure is        illustrated in Scheme 1 below.

These procedures are described in, for example, E. J. Cragoe, “TheSynthesis of Amiloride and Its Analogs” (Chap 3) in Amiloride and ItsAnalogs, pp. 25-36. Other processes for preparing amiloride analogs aredescribed in, for example, U.S. Pat. No. 3,318,813, to Cragoe,particularly at methods A, B, C, and D of the '813 patent. Still otherprocesses which may be adapted for the preparation of the compounds ofthe invention are described in PCT Publication Nos. WO2003/07182,WO2005/108644, WO2005/022935, U.S. Pat. No. 7,064,129, U.S. Pat. No.6,858,615, U.S. Pat. No. 6,903,105, WO 2004/073629, WO 2007/146869, andWO 2007/018640.

Generally, the compounds of the invention may be conveniently preparedby treating a compound of Formula (a) with an amine of Formula (b). Morespecifically, compounds of Formula (a) are treated with the amine ofFormula (b) in a suitable solvent such as methanol, ethanol, ortetrahydrofuran, and a base such as triethylamine (TEA), ordi-isoproylethylamine (DIPEA), with heating to elevated temperature,e.g., 70° C. Further purification, resolution of stereoisomers,crystallization and/or preparation of salt forms may be carried outusing conventional techniques.

As will be apparent to those skilled in the art, in certain instances,the starting or intermediate compounds in the synthesis may possessother functional groups which provide alternate reactive sites.Interference with such functional groups may be avoided by utilizationof appropriate protecting groups, such as amine or alcohol protectinggroups, and where applicable, appropriately prioritizing the syntheticsteps. Suitable protecting groups will be apparent to those skilled inthe art. Methods are well known in the art for installing and removingsuch protecting groups and such conventional techniques may be employedin the processes of the instant invention as well.

The following specific examples which are provided herein for purposesof illustration only and do not limit the scope of the invention, whichis defined by the claims.

Material and methods. All reagent and solvents were purchased fromAldrich Chemical Corp. Chem-Impex International Inc. and TCI chemicalindustry Co. Ltd. NMR spectra were obtained on either a Bruker AC 400(¹H NMR at 400 MHz and ¹³C NMR at 100 MHz) or a Bruker AC 300 (¹H NMR at300 MHz and ¹³C NMR at 75 MHz). Proton spectra were referenced totetramethylsilane as an internal standard and the carbon spectra werereferenced to CDCl₃, CD₃OD, or DMSO-d₆ (purchased from Aldrich orCambridge Isotope Laboratories, unless otherwise specified). Flashchromatography was performed on a Combiflash system (Combiflash Rf,Teledyne Isco) charged with silica gel column (Redi Sep. Rf, TeledyneIsco) or reverse phase column (High performance C18 Gold column). ESIMass spectra were obtained on a Shimadzu LCMS-2010 EV Mass Spectrometer.HPLC analyses were obtained using a Waters XTerra MS C18 5 μm 4.6×150 mmAnalytical Column detected at 220 nm (unless otherwise specified) on aShimadzu Prominence HPLC system. The following time program was usedwith a flow rate of 1.0 mL per minute:

Time Percent A Percent B (min) (H₂O with 0.05% TFA) (CH₃CN with 0.05%TFA) 2.50 90 10 20.00 10 90 30.00 10 90 32.50 90 10UPLC analyses were obtained using a Waters ACQUITY UPLC HSS T3 1.8 μm2.1×100 mm Analytical Column detected at 220 nm (unless otherwisespecified) on a Shimadzu Prominence UFLC system. The following timeprogram was used with a flow rate of 0.3 mL per minute:

Percent B Percent A (CH₃CN/Water 80:20% Time (H₂O with 0.05% NH₄COOHwith 0.05% NH₄COOH (min) and 0.1% HCOOH) and 0.1% HCOOH) 1.00 90 10 4.0030 70 5.00 30 70 5.50 90 10 6.50 90 10

Preparation of tert-butyl 3-oxopropylcarbamate (2)

To a solution of oxalyl chloride (8.56 mL, 98.15 mmol) in CH₂Cl₂ (200mL) was added DMSO (8.70 mL, 122.5 mmol) at −78° C. After 30 min,compound 1 (8.60 g, 49.90 mmol) was added at −78° C. and the reactionmixture was stirred for another 30 min. Triethylamine (41 mL, 294 mmol)was added and the reaction mixture was continued to be stirred at −78°C. for 30 min, then allowed to be warmed to 0° C. and stirred for 1 h.The reaction mixture was partitioned between CH₂Cl₂ (300 mL) and water(300 mL). The aqueous layer was separated and extracted with CH₂Cl₂(2×300 mL). The combined organic extracts were dried over Na₂SO₄ andconcentrated. The residue was purified by column chromatography (silicagel, 49:1 CHCl₃/MeOH) to afford aldehyde 2 as a yellow liquid: ¹H NMR(300 MHz, CD₃OD) δ 9.80 (s, 1H), 4.94-4.82 (br s, 1H), 3.42 (dd, J=12.1Hz, 6.0 Hz, 2H), 2.70 (t, J=6.0 Hz, 2H), 1.43 (s, 9H).

Preparation of(S)-4-(4-(4-(benzyloxycarbonylamino)but-1-ynyl)phenyl)-2-(tert-butoxycarbonylamino)butanoicacid (I-b)

To a solution of methyl ester I-a (5.00 g, 10.12 mmol) in THF/MeOH/H₂O(60 mL/60 mL/20 mL) was added NaOH (2.40 g, 60.72 mmol) and the reactionmixture was stirred at room temperature for 2 h. The pH value wasadjusted to 9 with 1 N aq HCl and organic solvent was removed. The pHvalue of residue was adjusted to 5, and the suspension was partitionedbetween CH₂Cl₂ (500 mL) and water (500 mL). The aqueous layer wasseparated and extracted with CH₂Cl₂ (2×500 mL). The combined organicextracts were dried over Na₂SO₄ and concentrated to afford compound I-bas a brown solid: ¹H NMR (400 MHz, DMSO-d6) δ □7.37-7.30 (m, 5H), 7.27(d, J=8.4 Hz, 2H), 7.14 (d, J=8.4 Hz, 2H), 6.73 (brs, 1H), 5.03 (s, 2H),3.75-3.69 (m, 1H), 3.21 (q, J=6.4 Hz, 2H), 2.60-2.47 (m, 4H), 1.97-1.76(m, 2H), 1.38 (s, 9H).

Preparation of(S)-4-(4-(4-(benzyloxycarbonylamino)but-1-ynyl)phenyl)-2-(tert-butoxycarbonylamino)butanoicamide (I-c)

To a solution of acid I-b (4.40 g, 9.10 mmol) in THF (60 mL) was addedNMM (1.50 mL, 13.65 mmol) and i-BCF (1.55 mL, 11.91 mmol) at 0° C. Thereaction mixture was stirred at the same temperature for 2 h and NH₃(7.0 N in methanol, 13 mL, 91 mmol) was added dropwise. The reactionmixture was continued to be stirred at 0° C. for 2 h, then allowed to bewarmed to room temperature and stirred for 16 h. After concentration,the residue was partitioned between CH₂Cl₂ (300 mL) and water (300 mL).The aqueous layer was separated and extracted with CH₂Cl₂ (2×300 mL).The combined organic extracts were dried over Na₂SO₄ and concentrated.The residue was purified by column chromatography (silica gel, 30:1CHCl₃/MeOH) to afford amide I-c as a yellow solid: ¹H NMR (400 MHz,CD₃OD) δ 7.36-7.24 (m, 7H), 7.13 (d, J=8.4 Hz, 2H), 5.08 (s, 2H),4.02-3.96 (m, 1H), 2.72-2.56 (m, 2H), 2.57 (t, J=7.1 Hz, 2H), 2.07-1.86(m, 4H), 1.45 (s, 9H).

Preparation of Compound (I-d)

A suspension of I-c (3.40 g, 7.0 mmol) and 10% Lindlar's Catalyst (2.00g) in EtOH (100 mL) was subjected to hydrogenation conditions (1 atm)for 36 h at room temperature. The reaction mixture was filtered throughcelite and washed with MeOH. The filtrate was concentrated in vacuum andthe residue was purified by column chromatography (silica gel, 95:5CHCl₃/CH₃OH) to afford compound I-d as a yellow solid: ¹H NMR (300 MHz,CD₃OD) δ 7.35-7.23 (m, 5H), 7.21-7.12 (m, 2H), 7.07 (s, 2H), 5.04 (s,2H), 4.06-3.94 (m, 1H), 3.21 (t, J=7.0 Hz, 1H), 3.11 (t, J=7.0 Hz, 1H),2.77-2.46 (m, 4H), 2.10-1.77 (m, 4H), 1.67-1.51 (m, 2H), 1.45 (s, 9H).

Preparation of Compound (I-e)

Compound I-d (2.9 g, 6.0 mmol) was dissolved in 4 N HCl in dioxane (20mL) at room temperature and the solution was stirred for 1 h. Thesolvent was removed in vacuum to give compound I-e as a white solid: ¹HNMR (300 MHz, CD₃OD) δ 7.34-7.23 (m, 5H), 7.22-7.14 (m, 2H), 7.11 (s,2H), 5.05 (s, 2H), 3.98-3.90 (m, 1H), 3.21 (t, J=7.0 Hz, 1H), 3.11 (t,J=7.0 Hz, 1H), 2.69 (dd, J=17 Hz, 8.0 Hz, 2H), 2.57 (t, J=6.9 Hz, 1H),2.50 (ddd, J=9.3 Hz, 7.5 Hz, 2.1 Hz, 1H), 2.00-2.04 (m, 3H), 1.67-1.45(m, 3H).

Preparation of Compound (I-f)

To a solution of compound 1-e (2.40 g, 5.72 mmol) and aldehyde 2 (1.2 g,6.87 mmol) in MeOH (35 mL) was added acetic acid (0.5 mL) and thereaction mixture was stirred at room temperature for 10 min. Then sodiumcyanoborohydride (540 mg, 8.58 mmol) was added and the solution wascontinued to be stirred at room temperature for 3 h. Additional compound2 (0.3 equiv), AcOH (0.5 equiv), and NaCNBH₃ (0.5 equiv) were added andthe solution was continued to be stirred at room temperature for 12 h.After concentration, the residue was partitioned between EtOAc (300 mL)and saturated NaHCO₃ (300 mL). The aqueous layer was separated andextracted with EtOAc (2×300 mL). The combined organic extracts weredried over Na₂SO₄ and concentrated. The residue (crude I-f, 3.50 g) wasdirectly used for the next step without further purification.

Preparation of Compound (I-g)

To a solution of compound I-f (crude, 3.50 g) in MeOH (25 mL) was addedsaturated NaHCO₃ (25 mL) at 0° C. and the solution was stirred for 10min. Benzyl chloroformate (1.75 mL) was added dropwise and the reactionmixture was stirred for 2 h at 0° C., then allowed to be warmed to roomtemperature and stirred for 1 h. After concentration, the residue wasdissolved in CH₂Cl₂ (200 mL), then washed with water (300 mL) and brine(300 mL). The organic layer was dried over Na₂SO₄ and concentrated. Theresidue (crude 1-g, 3.50 g) was directly used for the next step withoutfurther purification.

Preparation of Compound (I-h)

Compound I-g (crude, 3.50 g) was dissolved in 4 N HCl in dioxane (30 mL)at room temperature and the solution was stirred for 1 h. Afterconcentration, the residue was neutralized with aqueous NH₄OH andpurified by column chromatography (silica gel, 16:1 CHCl₃/MeOH) toafford compound I-h as a yellow solid: ¹H NMR (300 MHz, CD₃OD)□7.45-7.22 (m, 10H), 7.21-6.99 (m, 4H), 5.15 (s, 2H), 5.04 (s, 2H),4.54-4.36 (m, 1H), 3.55-3.39 (m, 2H), 3.21 (t, J=7.2 Hz, 1H), 3.11 (t,J=7.2 Hz, 1H), 2.97-2.80 (m, 2H), 2.56 (t, J=7.2 Hz, 2H), 2.52-2.44 (m,4H), 2.28-2.01 (m, 2H), 1.91 (t, J=6.6 Hz, 2H), 1.64-1.43 (m, 2H).

Preparation of Compound I-j and I-k

To a solution of compound I-h (1.15 g, 2.00 mmol) and triol Ii (2.68 g,10.0 mmol) in methanol (35 mL) was added acetic acid (0.91 mL) and thereaction mixture was stirred at room temperature for 10 min. Sodiumcyanoborohydride (880 mg, 14.0 mmol) was added and the solution wascontinued to be stirred at room temperature for 2 h. Additional compoundI-i (6.0 equiv), AcOH (8.0 equiv), and NaCNBH₃ (8.0 equiv) were addedand the solution was continued to be stirred at room temperature for 16h. Hexanal (0.36 mL, 3.00 mmol), AcOH (0.91 mL), and NaCNBH₃ (0880 mg,14.0 mmol) were added and the reaction mixture was stirred for 2 h.After concentration, the residue was partitioned between EtOAc (300 mL)and saturated NaHCO₃ (200 mL). The aqueous layer was separated andextracted with EtOAc (2×300 mL). The combined organic extracts weredried over Na₂SO₄ and concentrated. The residue was purified by C-18reverse phase Gold column to afford compound I-j and compound I-k aswhite solids.

Data for benzyl2-((1-amino-4-(4-(4-(benzyloxycarbonylamino)butyl)phenyl)-1-oxobutan-2-yl)(3-(((2S,3R)-2,3-dihydroxy-3-((2S,4R,5R)-5-hydroxy-2-phenyl-1,3-dioxan-4-yl)propyl)((2S,3R)-2,3-dihydroxy-3-((4R,5R)-5-hydroxy-2-phenyl-1,3-dioxan-4-yl)propyl)amino)propyl)amino)acetate(compound I-j)

¹H NMR (400 MHz, CD₃OD) δ 7.53-7.39 (m, 4H), 7.37-7.22 (m, 16H),7.18-6.94 (m, 4H), 5.52-5.37 (m, 2H), 5.09 (s, 2H), 5.04 (s, 2H), 4.21(dd, J=11 Hz, 5.5 Hz, 2H) 4.01-3.89 (m, 4H), 3.88-3.81 (m, 2H),3.75-3.64 (m, 3H), 3.57 (t, J=9.5 Hz, 2H), 3.19 (t, J=7.1 Hz, 1H), 3.09(t, J=6.4 Hz, 2H), 2.75-2.40 (m, 12H), 2.25-2.08 (m, 1H), 2.04-1.86 (m,1H), 1.85-1.65 (m, 3H), 1.63-1.53 (m, 1H), 1.52-1.40 (m, 1H).

Data for benzyl2-((1-amino-4-(4-(4-(benzyloxycarbonylamino)butyl)phenyl)-1-oxobutan-2-yl)(3-(((2S,3R)-2,3-dihydroxy-3-((4R,5R)-5-hydroxy-2-phenyl-1,3-dioxan-4-yl)propyl)(hexyl)amino)propyl)amino)acetate(compound I-k)

¹H NMR (400 MHz, CD₃OD) of I-k, δ 7.58-7.22 (m, 15H), 7.20-6.95 (m, 4H),5.53-5.43 (m, 1H), 5.11 (s, 2H), 5.05 (s, 2H), 4.22 (dd, J=9.7 Hz, 4.8Hz, 1H) 4.00-3.83 (m, 4H), 3.80-3.69 (m, 1H), 3.59 (t, J=10.6 Hz, 1H),3.20 (t, J=6.8 Hz, 1H), 3.10 (t, J=5.8 Hz, 2H), 2.77-2.62 (m, 1H),2.61-2.31 (m, 10H), 2.27-2.14 (m, 1H), 2.06-1.89 (m, 1H), 1.86-1.54 (m,3H), 1.53-1.44 (m, 1H), 1.41-1.00 (m, 10H), 0.85 (t, J=5.9 Hz, 3H).

Preparation of Compound II-a

A suspension of I-j (700 mg, 0.65) and 10% Pd/C (300 mg) in EtOH/AcOH(40 mL/4 mL) was subjected to hydrogenation conditions (1 atm) for 16 hat room temperature. The reaction mixture was filtered through celiteand washed with MeOH. The filtrate was concentrated in vacuum to affordcompound II-a as a white solid: ¹H NMR (400 MHz, CD₃OD) δ 7.47-7.40 (m,4H), 7.35-7.26 (m, 7H), 7.10-7.07 (m, 3H), 5.49 (s, 2H), 4.24 (dd,J=10.7 Hz, 5.4 Hz, 1H), 4.18-4.09 (m, 2H), 4.00-3.88 (m, 3H), 3.87-3.82(m, 2H), 3.77-3.69 (m, 2H), 3.59 (t, J=10.0 Hz, 2H), 3.54-3.46 (m, 1H),3.06 (dd, J=12.7 Hz, J=9.0 Hz, 1H), 3.00-2.93 (m, 1H), 2.92 (t, J=8.1Hz, 2H), 2.83-2.71 (m, 4H), 2.66-2.51 (m, 4H), 2.06-1.85 (m, 4H), 1.95(s, 9H), 1.73-1.57 (m, 4H), 1.38-1.00 (m, 2H).

Preparation of Compound II-c

To a solution of compound II-a (650 mg, 0.65 mmol) and methyl3,5-diamino-6-chloropyrazine-2-carbonylcarbamimidothioate hydroiodicacid salt (II-b, 409 mg, 1.05 mmol) in EtOH (25 mL) was added DIPEA(0.92 mL, 5.20 mmol) at room temperature. The reaction mixture washeated at 70° C. in a sealed tube for 2 h, then cooled to roomtemperature, and concentrated in vacuum. The residue was purified bycolumn chromatography (silica gel, 9:1 CH₂Cl₂/MeOH, 80:18:2CHCl₃/CH₃OH/NH₄OH) to afford compound II-c as a yellow solid: ¹H NMR(400 MHz, CD₃OD) δ 7.48-7.41 (m, 4H), 7.35-7.26 (m, 6H), 7.10 (brs, 4H),5.45 (s, 2H), 4.22 (dd, J=10.7 Hz, 5.2 Hz, 2H), 4.00-3.90 (m, 4H),4.00-3.88 (m, 2H), 3.85 (dd, J=5.4 Hz, 3.0 Hz, 2H), 3.71 (t, J=2.3 Hz,1H), 3.69 (t, J=2.3 Hz, 1H), 3.58 (t, J=11.4 Hz, 2H), 3.25 (t, J=7.6 Hz,2H), 3.05 (t, J=6.7 Hz, 1H), 2.73-2.41 (m, 6H), 1.89-1.77 (m, 2H),1.75-1.53 (m, 6H).

Preparation of the Hydrochloride Salt of3,5-diamino-N—(N-(4-(4-((S)-4-amino-3-(3-(bis((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)phenyl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide(II-d)

A solution of compound II-c (260 mg, 0.25 mmol) in 1 N aq HCl (25 mL)was stirred at room temperature for 2 h. The solvent was removed and theresidue was purified by C-18 reverse phase Gold column to affordcompound II-d as a yellow hygroscopic solid: ¹H NMR (400 MHz, CD₃OD) δ7.23-7.12 (m, 4H), 4.29-4.18 (m, 2H), 4.05 (t, J=6.2 Hz, 1H), 3.90-3.84(m, 2H), 3.82-3.79 (m, 1H), 3.78-3.76 (m, 1H), 3.74-3.63 (m, 6H),3.61-3.40 (m, 8H), 3.34 (t, J=6.8 Hz, 2H), 3.26-3.08 (m, 2H), 2.76-2.61(m, 4H), 2.36-2.25 (m, 2H), 2.24-2.15 (m, 2H), 1.81-1.67 (m, 4H).

Preparation ofIII-a—(2S)-4-(4-(4-aminobutyl)phenyl)-2-(3-(((2S,3R)-2,3-dihydroxy-3-((4R,5R)-5-hydroxy-2-phenyl-1,3-dioxan-4-yl)propyl)(hexyl)amino)propylamino)butanamide triacetate

A suspension of I-k (450 mg, 0.54) and 10% Pd/C (200 mg) in EtOH/AcOH(20 mL/2 mL) was subjected to hydrogenation conditions (1 atm) for 6 hat room temperature. The reaction mixture was filtered through celiteand washed with MeOH. The filtrate was concentrated in vacuum to affordcompound III-a as a white solid: ¹H NMR (400 MHz, CD₃OD) δ 7.50-7.43 (m,2H), 7.36-7.30 (m, 3H), 7.13-7.09 (m, 4H), 5.54 (s, 1H), 4.25 (dd,J=10.7 Hz, 5.1 Hz, 2H), 4.17 (ddd, J=9.3 Hz, 5.8 Hz, 3.1 Hz, 1H), 3.98(dd, J=9.5 Hz, 5.3 Hz, 1H), 3.91 (dd, J=5.6 Hz, 1.8 Hz, 1H), 3.78 (dd,J=9.5 Hz, 2.2 Hz, 1H), 3.62 (t, J=10.4 Hz, 1H), 3.29-3.16 (m, 2H),3.14-3.0 (m, 2H), 3.04-2.94 (m, 1H), 2.90 (t, J=7.1 Hz, 2H), 2.72 (t,J=5.3 Hz, 2H), 2.67-2.57 (m, 4H), 1.94 (s, 9H), 1.91-1.84 (m, 2H),1.83-1.76 (m, 2H), 1.73-1.54 (m, 6H), 1.33-1.15 (m, 7H), 0.86 (t, J=8.1Hz, 3H) □

Preparation ofIII-c—3,5-diamino-N—(N-(4-(4-((3S)-4-amino-3-(3-(((2S,3R)-2,3-dihydroxy-3-((4R,5R)-5-hydroxy-2-phenyl-1,3-dioxan-4-yl)propyl)(hexyl)amino)propylamino)-4-oxobutyl)phenyl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide

To a solution of compound III-a (400 mg, 0.48 mmol) and methyl3,5-diamino-6-chloropyrazine-2-carbonylcarbamimidothioate hydroiodicacid salt (III-b, 302 mg, 0.77 mmol) in EtOH (15 mL) was added DIPEA(0.68 mL, 3.84 mmol) at room temperature. The reaction mixture washeated at 70° C. in a sealed tube for 2 h, then cooled to roomtemperature, and concentrated in vacuo. The residue was purified bycolumn chromatography (silica gel, 9:1 CH₂Cl₂/MeOH, 80:18:2CHCl₃/CH₃OH/NH₄OH) to afford compound III-c as a yellow solid: ¹H NMR(400 MHz, CD₃OD) δ 7.46 (dd, J=8.0 Hz, 4.6 Hz, 2H), 7.33-7.28 (m, 3H),7.11 (brs, 4H), 5.52 (s, 1H), 4.23 (dd, J=10.8 Hz, 5.2 Hz, 1H),4.02-3.92 (m, 2H), 3.89 (dd, J=5.3 Hz, 2.1 Hz, 1H), 3.75 (dd, J=9.3 Hz,2.2 Hz, 1H), 3.60 (t, J=10.5 Hz, 1H), 3.29-3.21 (m, 2H), 3.07 (t, J=7.1Hz, 1H), 2.76 (dd, J=12.7 Hz, 5.6 Hz, 2H), 2.68-2.41 (m, 10H), 1.93-1.78(m, 2H), 1.76-1.53 (m, 6H), 1.47-1.37 (m, 2H), 1.32-1.16 (m, 6H), 0.86(t, J=8.1 Hz, 3H).

Preparation of the Hydrochloride Salt of3,5-diamino-N—(N-(4-(4-((S)-4-amino-3-(3-(hexyl((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)phenyl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide(III-d)

A solution of compound III-c (230 mg, 0.27 mmol) in 1 N aq HCl (20 mL)was stirred at room temperature for 3 h. The solvent was removed and theresidue was purified by C-18 reverse phase Gold column to affordcompound III-d as a yellow hygroscopic solid: ¹H NMR (400 MHz, CD₃OD) δ7.16 (s, 4H), 4.18 (dd, J=12.0 Hz, 5.6 Hz, 1H), 4.03-3.95 (m, 1H), 3.84(dd, J=4.9 Hz, 1.2 Hz, 1H), 3.78 (dd, J=10.5 Hz, 3.0 Hz, 1H), 3.74-3.63(m, 3H), 3.42-3.32 (m, 6H), 3.28-3.21 (m, 2H), 3.19-3.04 (m, 2H),2.76-2.62 (m, 4H), 2.30-2.13 (m, 4H), 1.84-1.65 (m, 6H), 1.46-1.32 (m,6H), 0.93 (t, J=7.2 Hz, 3H).

Preparation of Compound IV-d—4-(4-methoxynaphthalen-1-yl)butanoic acid

To a solution of 4-(4-methoxynaphthalen-1-yl)-4-oxobutanoic acid,compound IV-c (100 g, 387.5 mmol), in toluene (500 mL) and concentratedhydrochloric acid (500 mL) was added Zn dust (251 g, 3.87 mol) portionwise at room temperature. The reaction mixture was heated to reflux for2 h, cooled down to room temperature and filtered through celite. Afterthe filtrate was concentrated to 50%, the resulting precipitate wasfiltered and dried to afford compound IV-d as an off-white solid: ¹H NMR(400 MHz, DMSO-d₆) δ 12.05 (s, 1H), 8.18 (dd, J=8.0 Hz, 1.2 Hz, 1H),8.04 (d, J=8.0 Hz, 1H), 7.58-7.47 (m, 2H), 7.26 (d, J=7.6 Hz, 1H), 6.89(d, J=8.0 Hz, 1H), 3.94 (s, 3H), 2.96 (t, J=7.6 Hz, 2H), 2.30 (t, J=7.6Hz, 2H), 1.85 (t, J=7.6 Hz, 2H).

Preparation of CompoundIV-e—(S)-4-benzyl-3-(4-(4-methoxynaphthalen-1-yl)butanoyl)oxazolidin-2-one

To a solution of compound IV-d (43.5 g, 245.9 mmol) in dry THF (500 mL)was added n-butyl lithium drop wise at −78° C. and the reaction mixturewas stirred for 45 min to give a solution of compound IV-b. To aseparate solution of compound IV-d (50.0 g, 204.9 mmol) in dry THF (100mL) was added NMM (25.0 g, 245.9 mmol) and i-BCF (30.7 g, 245.9 mmol)drop wise at 0° C. The reaction mixture was stirred for another 30 minat the same temperature, and then the prepared solution of compound IV-bwas added slowly at 0° C. The reaction mixture was stirred for another 3h at room temperature, quenched with satd NH₄Cl, concentrated to removeTHF, and partitioned between EtOAc (1000 mL) and water (1000 mL). Theaqueous layer was separated and extracted with EtOAc (2×1000 mL). Thecombined organic extracts were dried over Na₂SO₄ and concentrated. Theresidue was purified by column chromatography (silica gel, 30:70EtOAc/hexanes) to afford compound IV-e as a white solid: ¹H NMR (400MHz, DMSO-d₆) δ 8.19 (d, J=8.3, 1H), 8.09 (d, J=8.3, 1H), 7.60-7.48 (m,2H), 7.31-7.19 (m, 6H), 6.91 (d, J=7.8 Hz, 1H), 4.69-4.63 (m, 1H), 4.31(t, J=8.6 Hz, 1H), 4.16 (dd, J=8.8 Hz, 2.8 Hz, 1H), 3.95 (s, 3H),3.03-2.99 (m, 2H), 2.95-2.89 (m, 2H), 1.98-1.93 (m, 2H).

Preparation of CompoundIV-f—(S)-3-((S)-2-azido-4-(4-methoxynaphthalen-1-yl)butanoyl)-4-benzyloxazolidin-2-one

To a solution of compound IV-e (10.0 g, 24.81 mmol) in dry THF (70 mL)was added KHMDS (6.40 g, 32.3 mmol) portion wise at −78° C. After theresulting mixture was stirred for 30 min, trisyl azide (11.5 g, 37.2mmol) was added and the reaction mixture was stirred for 2-3 min. Aceticacid (9.0 g, 148.8 mmol) followed by tetramethyl ammonium acetate (13.2g, 99.24 mmol) was added slowly at the same temperature. The reactionmixture was allowed to be warmed to 27° C., stirred for 16 h, quenchedwith satd NaHCO₃ (300 mL), concentrated to remove THF and extracted withEtOAc (2×300 mL). The combined organic extracts were dried over Na₂SO₄and concentrated. The residue was purified by column chromatography(silica gel, 30:70 EtOAc/Hexane) to afford compound IV-f as a colorlessoil: ¹H NMR (300 MHz, CDCl₃) δ 8.30 (t, J=6.1 Hz, 1H), 7.99 (d, J=8.3Hz, 1H), 7.56-7.47 (m, 2H), 7.37-7.28 (m, 3H), 7.20-7.16 (m, 2H), 6.74(d, J=7.8 Hz, 1H), 5.12-5.08 (m, 1H), 4.54-4.49 (m, 1H), 4.16-4.11 (m,2H), 3.98 (s, 3H), 3.33-3.27 (m, 3H), 2.84-2.77 (m, 1H), 2.35-2.04 (m,2H).

Preparation of CompoundIV-g—(S)-2-azido-4-(4-methoxynaphthalen-1-yl)butanoic acid

To a solution of compound IV-f (6.10 g, 13.7 mmol) in THF/H₂O (70 mL/30mL) was added H₂O₂ (2.80 g, 82.2 mmol) followed by LiOH (1.15 g, 27.4mmol) portion wise at 0° C. The reaction mixture was stirred for 3 h atthe same temperature, quenched with satd Na₂SO₃ (200 mL), concentratedunder reduced pressure to remove THF and washed with CH₂Cl₂ (200 mL).The aqueous layer was acidified with 1N aq HCl and extracted with CH₂Cl₂(2×250 mL). The combined organic extracts were dried over Na₂SO₄,concentrated and washed with MTBE to afford compound IV-g as anoff-white solid: ¹H NMR (400 MHz, DMSO-d₆) δ 13.15 (s, 1H), 8.19 (dd,J=8.0 Hz, 1.2 Hz, 1H), 8.00 (d, J=8.4 Hz, 1H), 7.60-7.48 (m, 2H), 7.29(d, J=7.8 Hz, 1H), 6.90 (d, J=7.8 Hz, 1H), 4.21-4.18 (m, 1H), 3.94 (s,3H), 3.07-3.04 (m, 2H), 2.13-1.89 (m, 2H).

Preparation of CompoundIV-h—(S)-2-amino-4-(4-methoxynaphthalen-1-yl)butanoic acid acetate

A suspension of compound IV-g (3.20 g, 11.2 mmol) and 10% Pd/C (1.60 g)in AcOH/H₂O (80 mL/20 mL) was subjected to hydrogenation conditions (1atm) for 3 h at room temperature. The reaction mixture was filteredthrough celite and washed with MeOH. The filtrate was concentrated invacuum to afford acetic salt IV-h as a yellow solid: ¹H NMR (300 MHz,DMSO-d₆) δ 13.15 (s, 1H), 8.18 (d, J=8.1 Hz, 1H), 8.08 (d, J=8.1 Hz,1H), 7.57-7.46 (m, 2H), 7.28 (d, J=7.6 Hz, 1H), 6.89 (d, J=7.8 Hz, 1H),3.93 (s, 3H), 3.04 (t, J=6.9 Hz, 2H), 2.08-1.90 (m, 2H).

Preparation of CompoundIVA—(S)-2-amino-4-(4-hydroxynaphthalen-1-yl)butanoic acid hydrobromide

To a solution of compound IV-h (2.80 g, 10.81 mmol) in acetic acid (30mL) was added hydrobromic acid (30 mL) drop wise at room temperature andthe reaction mixture was refluxed for 4 h. The reaction mixture wascooled to room temperature and concentrated. The residue was dilutedwith H₂O (15 mL), slightly basified with ammonia and crystalized overnight to afford compound IV-i as a brown solid: ESI-MS m/z 246[C₁₄H₁₅NO₃+H]⁺.

Preparation of Compound IV-j—(S)-methyl2-amino-4-(4-hydroxynaphthalen-1-yl)butanoate

Acetyl chloride (13.5 g, 171.4 mmol) was added to dry methanol (70 mL)at 0° C. and then compound IV-i (6.00 g, 24.48 mmol) was added. Thereaction mixture was refluxed for 4 h and concentrated. The residue waspartitioned between CH₂Cl₂ (300 mL) and saturated NaHCO₃ (300 mL). Theaqueous layer was separated and extracted with CH₂Cl₂ (2×300 mL). Thecombined organic extracts were dried over Na₂SO₄ and concentrated toafford compound IV-j as a colorless oil: ESI-MS m/z 260 [C₁₅H₁₇NO₃+H]⁺.

Preparation of Compound IV-k—(S)-methyl2-(tert-butoxycarbonylamino)-4-(4-hydroxynaphthalen-1-yl)butanoate

To a solution of compound IV-j (4.80 g, 18.53 mmol) in MeOH/H₂O (40mL/10 mL) was added NaHCO₃ (6.20 g, 74.13 mmol) and Boc₂O (4.85 g, 22.2mmol) at 0° C. The resulting mixture was allowed to warm to roomtemperature and stirred for 3 h. The reaction mixture was partitionedbetween CH₂Cl₂ (200 mL) and water (200 mL). The aqueous layer wasseparated and extracted with CH₂Cl₂ (2×200 mL). The combined organicextracts were washed with brine, dried over Na₂SO₄ and concentrated togive compound IV-k as a colorless oil: ¹H NMR (300 MHz, DMSO-d₆) δ 9.91(s, 1H), 8.15 (dd, J=8.0 Hz, 1.2 Hz, 1H), 7.98 (d, J=8.3 Hz, 1H),7.52-7.41 (m, 3H), 7.13 (d, J=7.7 Hz, 1H), 6.77 (d, J=7.6 Hz, 1H),4.05-3.99 (m, 1H), 3.66 (s, 3H), 3.04-2.86 (m, 2H), 1.97-1.91 (m, 2H),1.42 (s, 9H).

Preparation of Compound IV-l—(S)-methyl2-(tert-butoxycarbonylamino)-4-(4-(trifluoromethylsulfonyloxy)naphthalen-1-yl)butanoate

To a solution of compound IV-k (9.50 g, 26.46 mmol) in pyridine (50 mL)was added triflic anhydride (8.90 g, 282.1 mmol) at 0° C., and thereaction mixture was stirred at room temperature for 2.5 h. Afterconcentration, the reaction mixture was partitioned between CH₂Cl₂ (300mL) and water (300 mL). The aqueous layer was separated and extractedwith CH₂Cl₂ (2×300 mL). The combined organic extracts were washed withbrine, dried over Na₂SO₄ and concentrated to afford compound IV-1 as abrown oil: ESI-MS m/z 492 [C₂₁H₂₄F₃NO₇S+H]⁺.

Preparation of Compound IV-n—(S)-methyl4-(4-(4-(benzyloxycarbonylamino)but-1-ynyl)naphthalen-1-yl)-2-(tert-butoxycarbonylamino)butanoate

To a solution of compound IV-l (6.00 g, 12.21 mmol) in anhydrous CH₃CN(100 mL) was added TEA (4.93 g, 48.8 mmol), 10% (t-Bu)₃P in hexanes(0.50 g, 2.44 mmol), benzyl but-3-ynylcarbamate (IV-m, 3.70 g, 18.3mmol) and CuI (0.11 g, 0.61 mmol) at room temperature. The resultingmixture was degassed with Argon for 3 min and Pd(PPh₃)₄ (1.40 g, 1.22mmol) was added rapidly in one portion. After degassing with Argon for 5min, the resulting mixture was refluxed for 5 h. The reaction mixturewas concentrated in vacuum and the residue was purified by column(silica gel, 40:60 hexanes/EA) to afford compound IV-n as a brown oil:¹H NMR (300 MHz, CDCl₃) δ 8.35-8.31 (m, 1H), 7.97-7.94 (m, 1H),7.54-7.50 (m, 3H), 7.37-7.29 (m, 6H), 5.29-5.13 (m, 4H), 4.44 (br s,1H), 3.73 (s, 3H), 3.56-3.49 (m, 2H), 3.14-3.07 (m, 2H), 2.79 (t, J=6.6Hz, 2H), 2.10-1.98 (m, 2H), 1.42 (s, 9H).

Preparation of CompoundIV-o—(S)-4-(4-(4-(benzyloxycarbonylamino)but-1-ynyl)naphthalen-1-yl)-2-(tert-butoxycarbonylamino)butanoicacid

To a solution of methyl ester IV-n (3.40 g, 6.25 mmol) in THF/MeOH/H₂O(30 mL/30 mL/10 mL) was added NaOH (0.75 g, 18.7 mmol) and the reactionmixture was stirred at room temperature for 3 h. The pH value wasadjusted to 9 with 1 N aq HCl and organic solvent was removed. The pHvalue was adjusted to 5, and the suspension was partitioned betweenCH₂Cl₂ (200 mL) and water (200 mL). The aqueous layer was separated andextracted with CH₂Cl₂ (2×200 mL). The combined organic extracts weredried over Na₂SO₄ and concentrated to afford compound IV-o as a brownsolid: ¹H NMR (300 MHz, CDCl₃) δ 8.28 (t, J=7.0 Hz, 1H), 7.91 (br s,1H), 7.45 (d, J=6.9 Hz, 3H), 7.34-7.29 (m, 6H), 7.15 (d, J=6.3 Hz, 1H),5.29-5.12 (m, 4H), 4.31 (br s, 1H), 3.51 (d, J=6.2 Hz, 2H), 3.06 (br s,1H), 2.76 (t, J=6.2 Hz, 2H), 2.30-2.04 (m, 2H), 1.42 (s, 9H).

Preparation of CompoundIV-p—(S)-4-(4-(4-(benzyloxycarbonylamino)but-1-ynyl)naphthalen-1-yl)-2-(tert-butoxycarbonylamino)butanoicacid

To a solution of acid IV-o (2.90 g, 5.47 mmol) in THF (40 mL) was addedNMM (0.82 g, 8.2 mmol) and i-BCF (0.97 g, 7.11 mmol) at 0° C. Thereaction mixture was stirred at the same temperature for 30 min and NH₃(7.0 N in methanol, 6.0 mL, 43.7 mmol) was added dropwise. The reactionmixture was continued to be stirred at 0° C. for 2 h, allowed to bewarmed to room temperature and stirred for 16 h. After concentration,the residue was partitioned between CH₂Cl₂ (100 mL) and water (100 mL).The aqueous layer was separated and extracted with CH₂Cl₂ (2×100 mL).The combined organic extracts were dried over Na₂SO₄ and concentrated.The residue was washed with MTBE to afford amide IV-p as a yellow solid:¹H NMR (400 MHz, DMSO-d₆) δ 8.29 (br s, 1H), 8.13 (br s, 1H), 7.59-7.53(m, 3H), 7.34-7.28 (m, 9H), 7.03 (t, J=7.2 Hz, 1H), 5.05 (s, 2H), 3.98(br s, 1H), 3.31 (br s, 2H), 3.13-3.01 (m, 3H), 2.72 (t, J=6.6 Hz, 2H),1.98-1.84 (m, 2H), 1.42 (s, 9H).

Preparation of Compound IV-q—(S)-tert-butyl1-amino-4-(4-(4-aminobutyl)naphthalen-1-yl)-1-oxobutan-2-ylcarbamate

A suspension of compound IV-p (2.30 g, 4.34 mmol) and 10% Pd/C (1.20 g)in EtOH (50 mL) was subjected to hydrogenation conditions (1 atm) for 16h at room temperature. The reaction mixture was filtered through celiteand washed with EtOH. The filtrate was concentrated in vacuum and washedwith MTBE/hexanes to afford acetic salt IV-q as an off-white solid: ¹HNMR (400 MHz, CDCl₃) δ 8.05-8.01 (m, 2H), 7.50-7.42 (m, 2H), 7.24-7.20(m, 2H), 6.22 (br s, 1H), 5.50 (br s, 1H), 5.16 (d, J=8.0 Hz, 1H), 4.20(br s, 1H), 3.12 (t, J=8.1 Hz, 2H), 3.04 (t, J=7.5 Hz, 2H), 2.71 (t,J=7.0 Hz, 2H), 2.34-2.24 (m, 1H), 2.07-1.98 (m, 1H), 1.80-1.70 (m, 6H),1.45 (s, 9H).

Preparation of Compound IV-r

To a stirred solution of compound IV-q (1.4 g, 3.50 mmol) in dry CH₂Cl₂(25 mL) was added TEA (0.53 g, 5.25 mmol) and CbzCl (0.65 g, 3.85 mmol)at 0° C. The reaction mixture was stirred for 2 h at room temperatureand partitioned between CH₂Cl₂ (100 mL) and water (100 mL). The aqueouslayer was separated and extracted with CH₂Cl₂ (2×100 mL). The combinedorganic extracts were washed with brine, dried over Na₂SO₄ andconcentrated to afford compound IV-r as a yellow oil: ESI-MS m/z 534[C₃₁H₃₉N₃O₅+H]⁺.

Preparation of Compound IV-s

To a solution of compound IV-r (1.75 g, 3.28 mmol) in dry THF (10 mL)was added 4 N HCl in dioxane (20 mL) and the reaction mixture wasstirred for 6 h at room temperature. The solvent was removed in vacuumand the residue was washed with MTBE to afford compound IV-s as anoff-white solid: ¹H NMR (400 MHz, MeOD-d₃) δ 8.07-8.03 (m, 2H),7.53-7.49 (m, 2H), 7.31-7.27 (m, 7H), 5.05 (s, 2H), 4.05 (t, J=6.2 Hz,1H), 3.20-3.14 (m, 6H), 2.26-2.22 (m, 2H), 1.76-1.59 (m, 4H).

Preparation of Compound IV-t

To a solution of compound IV-s (1.2 g, 2.77 mmol) and aldehyde 2 (0.95g, 5.54 mmol) in MeOH (25 mL) was added acetic acid (0.5 mL) and thereaction mixture was stirred at room temperature for 10 min. Sodiumcyanoborohydride (0.25 g, 4.15 mmol) was added and the solution wascontinued to be stirred at room temperature for 16 h. Additionalcompound 2 (0.3 equiv), AcOH (0.3 equiv), and NaCNBH₃ (0.3 equiv) wereadded over the period of 3 h and this addition was repeated four timesuntil LC-MS showed >90% consumption of amine. After concentration, theresidue was partitioned between EtOAc (300 mL) and saturated NaHCO₃ (200mL). The aqueous layer was separated and extracted with EtOAc (2×300mL). The combined organic extracts were dried over Na₂SO₄ andconcentrated to afford IV-t, which was used in the next step withoutfurther purification.

Preparation of Compound IV-u

To a solution of compound IV-t (crude, 850 mg) in MeOH/H₂O (25 mL/12 mL)was added NaHCO₃ (0.36 g, 4.32 mmol) at 0° C. and the solution wasstirred for 10 min. Benzyl chloroformate (0.50 g, 2.88 mmol)) was addeddrop wise and the reaction mixture was stirred for 2 h at 0° C., thenallowed to be warmed to room temperature and stirred for 1 h. Afterconcentration, the residue was dissolved in CH₂Cl₂ (200 mL), then washedwith water (300 mL) and brine (300 mL). The organic layer was dried overNa₂SO₄ and concentrated to afford IV-u, which was used in the next stepwithout further purification.

Preparation of Compound IV-v

Compound IV-u (crude, 750 mg) was dissolved in 4 N HCl in dioxane (10mL) at room temperature and the solution was stirred for 2 h. Afterconcentration, the residue was washed with MTBE and neutralized withaqueous NH₄OH to afford compound IV-v as an off-white solid: ¹H NMR (400MHz, CD₃OD) δ 8.06 (br s, 2H), 7.48-7.46 (m, 2H), 7.31-7.19 (m, 11H),5.48 (s, 2H), 5.13-5.04 (m, 4H), 3.34-3.32 (m, 3H), 3.15 (t, J=6.9 Hz,4H), 3.04 (t, J=7.5 Hz, 2H), 2.58-2.40 (m, 3H), 2.12 (br s, 1H),1.76-1.57 (m, 6H).

Preparation of Compound IV-x and Compound IV-y

To a solution of compound IV-v (710 mg, 1.13 mmol) and triol IV-w (1.52g, 5.68 mmol) in methanol (50 mL) was added acetic acid (1.00 mL) andthe reaction mixture was stirred at room temperature for 30 min. Sodiumcyanoborohydride (490 mg, 7.91 mmol) was added and the solution wascontinued to be stirred at room temperature for 16 h. Additionalcompound IV-w (16.0 equiv), AcOH (20.0 equiv), and NaCNBH₃ (20.0 equiv)were added and the solution was continued to be stirred at roomtemperature for 72 h. Hexanal (0.45 g, 4.52 mmol), AcOH (0.91 mL), andNaCNBH₃ (350 mg, 5.65 mmol) were added and the reaction mixture wasstirred for 4 h. After concentration, the residue was partitionedbetween EtOAc (300 mL) and saturated NaHCO₃ (200 mL). The aqueous layerwas separated and extracted with EtOAc (2×300 mL). The combined organicextracts were dried over Na₂SO₄ and concentrated. The residue waspurified by C-18 reverse phase Gold column to afford compound IV-x andcompound IV-y as white solids:

Data for benzyl2-(((S)-1-amino-4-(4-(4-(benzyloxycarbonylamino)butyl)naphthalen-1-yl)-1-oxobutan-2-yl)(3-(bis((2S,3R)-2,3-dihydroxy-3-((4R,5R)-5-hydroxy-2-phenyl-1,3-dioxan-4-yl)propyl)amino)propyl)amino)acetate(Compound IV-x)

ESI-MS m/z 1130 [C₆₃H₇₆N₄O₁₅+H]⁺.

Data for benzyl2-(((S)-1-amino-4-(4-(4-(benzyloxycarbonylamino)butyl)naphthalen-1-yl)-1-oxobutan-2-yl)(3-(((2S,3R)-2,3-dihydroxy-3-((4R,5R)-5-hydroxy-2-phenyl-1,3-dioxan-4-yl)propyl)(hexyl)amino)propyl)amino)acetate(Compound IV-y)

ESI-MS m/z 962 [C₅₆H₇₂N₄O₁₀+H]⁺.

Preparation ofV-a—(2S)-4-(4-(4-aminobutyl)naphthalen-1-yl)-2-(3-(bis((2S,3R)-2,3-dihydroxy-3-((4R,5R)-5-hydroxy-2-phenyl-1,3-dioxan-4-yl)propyl)amino)propylamino)butanamideacetate

A suspension of IV-x (425 mg, 0.38 mmol) and 10% Pd/C (200 mg) inMeOH/AcOH (5.0 mL/1.0 mL) was subjected to hydrogenation conditions (1atm) for 8 h at room temperature. The reaction mixture was filteredthrough celite and washed with MeOH. The filtrate was concentrated invacuum and precipitated from MTBE/hexanes, to afford compound V-a as acolorless oil: ¹H NMR (300 MHz, CD₃OD) δ 8.10-8.05 (m, 2H), 7.55-7.21(m, 14H), 5.40 (s, 2H), 4.24-4.20 (m, 2H), 3.94-3.92 (m, 6H), 3.86-3.53(m, 12H), 3.15-3.01 (m, 8H), 2.92-2.75 (m, 4H), 1.94 (s, 9H), 1.76-1.33(m, 8H) □.

Preparation ofV-c—3,5-diamino-N—(N-(4-(4-((3S)-4-amino-3-(3-(bis((2S,3R)-2,3-dihydroxy-3-((4R,5R)-5-hydroxy-2-phenyl-1,3-dioxan-4-yl)propyl)amino)propylamino)-4-oxobutyl)naphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide

To a solution of compound V-a (356 mg, 0.34 mmol) and methyl3,5-diamino-6-chloropyrazine-2-carbonylcarbamimidothioate hydroiodicacid salt (V-b, 213 mg, 0.54 mmol) in EtOH (8.0 mL) was added DIPEA (353mg, 2.73 mmol) at room temperature. The reaction mixture was heated at70° C. in a sealed tube for 2 h, then cooled to room temperature, andconcentrated in vacuo. The residue was purified by column chromatography(silica gel, 10:1 CH₂Cl₂/MeOH, 8:2:0.2 CHCl₃/CH₃OH/NH₄OH) to affordcompound V-c as a yellow solid: ESI-MS m/z 537 [C₅₃H₆₉ClN₁₀O₁₂+2H]²⁺/2.

Preparation ofV-d—3,5-diamino-N—(N-(4-(4-((S)-4-amino-3-(3-(bis((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)naphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamidehydrochloride

A solution of compound V-c (120 mg, 0.111 mmol) in 1 N aq HCl (3.0 mL)and 3 N HCl in MeOH (3.0 mL) was stirred at room temperature for 3 h.The solvent was removed and the residue was purified by C-18 reversephase Gold column to afford compound V-d as a yellow hygroscopic solid:¹H NMR (400 MHz, D₂O) δ 8.13 (d, J=8.4 Hz, 1H), 7.82 (d, J=9.2 Hz, 1H),7.53-7.31 (m, 4H), 4.18-4.16 (m, 2H), 3.95 (br s, 1H), 3.78-3.74 (m,6H), 3.62-3.58 (m, 4H), 3.36-3.29 (m, 6H), 3.22-3.18 (m, 2H), 3.08-3.04(m, 6H), 2.17-2.14 (m, 4H), 1.85-1.73 (m, 4H); ESI-MS m/z 449[C₃₉H₆₁ClN₁₀O₁₂+2H]²⁺/2.

Preparation ofVI-a—(2S)-4-(4-(4-aminobutyl)naphthalen-1-yl)-2-(3-(((2S,3R)-2,3-dihydroxy-3-((4R,5R)-5-hydroxy-2-phenyl-1,3-dioxan-4-yl)propyl)(hexyl)amino)propylamino)butanamidetriacetate

A suspension of IV-y (270 mg, 0.28 mmol) and 10% Pd/C (120 mg) inMeOH/AcOH (5.0 mL/1.0 mL) was subjected to hydrogenation conditions (1atm) for 8 h at rt. The reaction mixture was filtered through celite andwashed with MeOH. The filtrate was concentrated in vacuum to affordcompound VI-a as a colorless oil: ¹H NMR (300 MHz, CD₃OD) δ 8.09-8.05(m, 2H), 7.54-7.21 (m, 9H), 5.46 (s, 1H), 4.24-4.21 (m, 2H), 3.95-3.94(m, 2H), 3.79-3.59 (m, 5H), 3.15-3.07 (m, 6H), 2.96-2.89 (m, 2H),2.76-2.75 (m, 2H), 1.94 (s, 9H), 1.90-1.62 (m, 10H), 1.28-1.22 (m, 6H),0.78-0.76 (m, 3H) □

Preparation of CompoundVI-c—3,5-diamino-N—(N-(4-(4-((3S)-4-amino-3-(3-(((2S,3R)-2,3-dihydroxy-3-((4R,5R)-5-hydroxy-2-phenyl-1,3-dioxan-4-yl)propyl)(hexyl)amino)propylamino)-4-oxobutyl)naphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide

To a solution of compound VI-a (209 mg, 0.24 mmol) and methyl3,5-diamino-6-chloropyrazine-2-carbonylcarbamimidothioate hydroiodicacid salt (VI-b, 130 mg, 0.38 mmol) in EtOH (5.0 mL) was added DIPEA(250 mg, 1.92 mmol) at room temperature. The reaction mixture was heatedat 70° C. in a sealed tube for 2 h, then cooled to rt, and concentratedin vacuo. The residue was purified by column chromatography (silica gel,10:1 CH₂Cl₂/MeOH, 8:2:0.2 CHCl₃/CH₃OH/NH₄OH) to afford compound VI-c asa yellow solid: ¹H NMR (400 MHz, CD₃OD) δ 8.08-8.06 (m, 2H), 7.50-7.41(m, 4H), 7.28-7.26 (m, 5H), 5.48 (s, 1H), 4.23 (dd, J=10.4 Hz, 5.2 Hz,1H), 3.90-3.88 (m, 3H), 3.75 (dd, J=9.6 Hz, 2.4 Hz, 1H), 3.58 (t, J=10.4Hz, 1H), 3.20-3.12 (m, 5H), 2.70-2.48 (m, 7H), 1.88-1.62 (m, 8H),1.43-1.41 (m, 2H), 1.26-1.17 (m, 6H), 0.83 (t, J=8.1 Hz, 3H).

Preparation of CompoundVI-d—3,5-diamino-N—(N-(4-(4-((S)-4-amino-3-(3-(hexyl((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)naphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamidehydrochloride

A solution of compound VI-c (98 mg, 0.108 mmol) in 1 N aq HCl (2.0 mL)and 3 N HCl in MeOH (2.0 mL) was stirred at rt for 2 h. The solvent wasremoved and the residue was purified by C-18 reverse phase Gold columnto afford compound VI-d as a yellow hygroscopic solid: ¹H NMR (400 MHz,D₂O) δ 8.12 (d, J=8.8 Hz, 1H), 7.83 (d, J=8.0 Hz, 1H), 7.51-7.30 (m,4H), 4.14-4.12 (m, 1H), 3.76-3.58 (m, 7H), 3.39-2.90 (m, 14H), 2.17-1.62(m, 10H), 1.28-1.19 (m, 6H), 0.78 (t, J=6.4 Hz, 3H); ESI-MS m/z 409[C₃₉H₆₁ClN₁₀O₇+2H]²⁺/2.

Preparation of Compound VII-c

Trimethyl phosphonoacetate VII-b (34.8 mL, 241 mmol) in 300 mL anhydrousCH₂Cl₂ was cooled to 0° C. and charged with DBU (30.5 mL, 322 mmol), andthe mixture was stirred for 15 min. Aldehyde VII-a (25.0 g, 134 mmol) in50 mL CH₂Cl₂ was charged dropwise. The reaction mixture was brought toroom temperature, stirred for 36 h, and quenched with 100 mL of water.The mixture was partitioned, and the aqueous layer was extracted withCH₂Cl₂ (3×150 mL). The combined organics were washed with brine, dried(Na₂SO₄), filtered, and concentrated, and the residue was purified bysilica-gel column chromatography (10:1 hexanes/ethyl acetate) to givethe desired trans-α,β-unsaturated ester VII-c (32.0 g, 99%) as a whitesolid: ¹H NMR (400 MHz, CDCl₃): δ 8.45 (d, J=16.0 Hz, 1H), 8.29 (dd,J=8.4, 1.5 Hz, 1H), 8.14 (d, J=8.6 Hz, 1H), 7.70 (d, J=7.7 Hz, 1H), 7.57(ddd, J=8.5, 7.0, 1.7 Hz, 1H), 7.49 (ddd, J=8.3, 6.7, 1.2 Hz, 1H), 6.78(d, J=8.2 Hz, 1H), 6.43 (d, J=16.0 Hz, 1H), 3.99 (s, 3H), 3.83 (s, 3H).

Preparation of Compound VII-d

A suspension of compound VII-c (32.0 g, 132 mmol) and 10% Pd/C (5.0 g)in EtOAc (400 mL) was subjected to hydrogenation conditions (1 atm) for16 h at room temperature. The reaction mixture was filtered throughCelite and washed with MeOH. The filtrate was concentrated under vacuumto afford VII-d (32 g, 99%) as a white solid: ¹H NMR (400 MHz, CDCl₃): δ8.31 (d, J=8.2 Hz, 1H), 7.94 (d, J=8.6 Hz, 1H), 7.54 (ddd, J=8.4, 7.0,1.5 Hz, 1H), 7.47 (ddd, J=8.3, 6.9, 1.3 Hz, 1H), 7.24 (d, J=8.2 Hz, 1H),6.83 (d, J=7.7 Hz, 1H), 3.97 (s, 3H), 3.68 (s, 3H), 3.33 (t, J=7.6 Hz, 2h), 2.72 (t, J=7.7 Hz, 2H).

Preparation of Compound VII-e

A solution of methyl ester VII-d (32.0 g, 131 mmol) in THF/MeOH/H₂O (200mL/200 mL/75 mL) was charged with NaOH (31.5 g, 786 mmol) and thereaction mixture was stirred at room temperature for 1 h. The solventwas removed and pH was adjusted to 1 with 1 N aqueous HCl; a white solidprecipitated, was filtered, washed with water, and dried under vacuum toafford acid VII-e (29.5 g, 98%) as a white solid: ¹H NMR (400 MHz,DMSO-d₆): δ 12.15 (brs, 1H), 8.19 (dd, J=8.6, 1.1 Hz, 1H), 7.99 (d,J=8.4 Hz, 1H), 7.57 (ddd, J=8.2, 7.9, 1.3 Hz, 1H), 7.50 (ddd, J=8.4,7.1, 1.5 Hz, 1H), 7.28 (d, J=7.9 Hz, 1H), 6.88 (d, J=8.1 Hz, 1H), 3.94(s, 3H), 3.21 (t, J=7.6 Hz, 2H), 2.66 (t, J=7.7 Hz, 2H).

Preparation of Compound VII-g

A solution of compound VII-f (26.8 g, 151 mmol) in dry THF (300 mL) wascharged with n-butyl lithium (76.0 mL, 2M solution in cyclohexane)dropwise at −78° C., and the reaction mixture was stirred for 1 h togive a solution of the lithium salt of compound VII-f. Another solutionof compound VII-e (29 g, 126 mmol) in dry THF (300 mL) was charged withNMM (20.7 mL, 189 mmol) and PivCl (18.6 mL, 151 mmol) dropwise at −78°C. The reaction mixture was stirred for 1 min at the same temperature,and the prepared solution of compound VIM was added slowly at −78° C.The reaction mixture was stirred for another 10 min, stirred for 1 h at0° C., stirred at room temperature for 30 min, quenched with saturatedNH₄Cl, concentrated to remove THF, and partitioned between CH₂Cl₂ (1000mL) and water (1000 mL). The aqueous layer was separated and extractedwith CH₂Cl₂ (2×1000 mL). The combined organic extracts were dried overNa₂SO₄ and concentrated. The residue was purified by columnchromatography (silica gel, CH₂Cl₂) to afford compound VII-g (16 g, 33%)as a white solid: ¹H NMR (400 MHz, CDCl₃): δ 8.30 (dd, J=8.6, 1.3 Hz,1H), 8.02 (d, J=8.2 Hz, 1H), 7.55 (ddd, J=8.5, 6.9, 1.6 Hz, 1H), 7.47(ddd, J=8.2, 6.9, 1.2 Hz, 1H), 7.34-7.22 (m, 5H), 7.17 (d, J=7.7 Hz,1H), 6.73 (d, J=8.0 Hz, 1H), 4.72-4.60 (m, 1H), 4.14 (d, J=2.4 Hz, 1H),4.13 (s, 1H), 3.47-3.25 (m, 5H), 3.96 (s, 3H), 2.76 (dd, J=13.2, 9.6 Hz,1H).

Preparation of Compound VII-h

A solution of compound VII-g (16.0 g, 41.1 mmol) in dry THF (500 mL) wascharged with KHMDS (12.8 g, 61.7 mmol) portionwise at −78° C. After theresulting mixture was stirred for 30 min, trisyl azide (19.0 g, 61.7mmol) was added and the reaction mixture was stirred for 5 min. Aceticacid (24.7 mL, 411 mmol) was added slowly at the same temperature,followed by tetramethyl ammonium acetate (10.9 g, 82.2 mmol). Thereaction mixture was warmed to 24° C., stirred for 16 h, quenched withsaturated NaHCO₃ (300 mL), concentrated to remove THF, and extractedwith CH₂Cl₂ (2×500 mL). The combined organic extracts were dried overNa₂SO₄ and concentrated. The residue was purified by columnchromatography (silica gel, 90:10 hexanes/EtOAc, followed by CH₂Cl₂) toafford compound VII-h (13.0 g, 74%) as a yellow solid: ¹H NMR (400 MHz,CDCl₃): δ 8.29 (d, J=8.6 Hz, 1H), 8.05 (d, J=8.9 Hz, 1H), 7.56 (ddd,J=8.1, 6.7, 1.2 Hz, 1H), 7.46 (ddd, J=8.2, 6.9, 1.2 Hz, 1H), 7.38 (d,J=8.1 Hz, 1H), 7.33-7.20 (m, 3H), 7.18-7.12 (m, 2H), 6.75 (d, J=8.2 Hz,1H), 5.47 (dd, J=8.4, 7.0 Hz, 1H), 4.44-4.35 (m, 1H), 4.02 (dd, J=9.2,2.7 Hz, 1H), 3.93 (s, 3H), 3.74 (t, J=8.4 Hz, 1H), 3.66 (dd, J=1.41, 7.0Hz, 1H), 3.46 (dd, J=14.3, 8.5 Hz, 1H), 3.24 (dd, J=13.4, 3.4 Hz, 1H),2.75 (dd, J=13.6, 9.7 Hz, 1H).

Preparation of Compound VII-i

A solution of compound VII-h (26.0 g, 60.9 mmol) in THF/H₂O (100 mL/35mL) was charged with H₂O₂ (41.4 mL, 366 mmol) followed by LiOH (5.11 g,122 mmol) portionwise at 0° C. The reaction mixture was stirred for 10min, stirred at room temperature for 1 h, quenched with saturated Na₂SO₃(200 mL), concentrated under reduced pressure to remove THF, and washedwith CH₂Cl₂ (500 mL). The aqueous layer was acidified with 1 N aqueousHCl and extracted with CH₂Cl₂ (2×500 mL). The combined organic extractswere dried over Na₂SO₄, concentrated, and triturated with MTBE to affordcompound VII-i (13.5 g, 82%) as an off-white solid: ¹H NMR (400 MHz,DMSO-d₆): δ 8.22 (dd, J=8.4, 1.4 Hz, 1H), 8.03 (d, J=8.4 Hz, 1H), 7.60(ddd, J=8.2, 6.8, 1.4 Hz, 1H), 7.52 (ddd, J=8.2, 6.8, 1.3 Hz, 1H), 7.35(d, J=8.0 Hz, 1H), 6.92 (d, J=8.0 Hz, 1H), 4.36 (dd, J=9.5, 5.0 Hz, 1H),3.96 (s, 3H), 3.59 (dd, J=14.9, 5.1 Hz, 1H), 3.25 (dd, J=14.7, 8.9 Hz,1H).

Preparation of Compound VII-j

A suspension of compound VII-ji (13.5 g, 49.6 mmol) and 10% Pd/C (1.35g) in AcOH/H₂O (300 mL/100 mL) was subjected to hydrogenation conditions(1 atm) for 3 h at room temperature. The reaction mixture was filteredthrough Celite and washed with AcOH/H₂O followed by MeOH. The filtratewas concentrated under vacuum to afford acetic salt VII-j (12.0 g, 80%)as a yellow solid: ESI-MS m/z 246 [C₁₄H₁₅NO₃+H]⁺.

Preparation of Compound VII-k

A solution of compound VII-j (12.0 g, 39.3 mmol) in acetic acid (130 mL)was charged with hydrobromic acid (130 mL) dropwise at room temperatureand the reaction mixture was refluxed for 3 h. The reaction mixture wascooled to room temperature and concentrated. The crude brown residueVII-k (10.5 g, 86%) was directly used for the next step without anypurification: ¹H NMR (400 MHz, DMSO-d₆): δ 10.17 (brs, 1H), 8.32 (brs,3H), 8.20 (dd, J=8.3, 1.5 Hz, 1H), 8.00 (d, J=8.5 Hz, 1H), 7.57 (ddd,J=8.2, 6.7, 1.2 Hz, 1H), 7.49 (ddd, J=8.2, 6.8, 1.1 Hz, 1H), 7.21 (d,J=7.7 Hz, 1H), 6.82 (d, J=7.7 Hz, 1H), 4.11-3.98 (m, 1H), 3.51-3.36 (m,2H).

Preparation of Compound VII-l

Acetyl chloride (16.8 mL, 236 mmol) was added to dry methanol (250 mL)at 0° C., followed by compound VII-k (10.5 g, 33.7 mmol). The reactionmixture was refluxed for 4 h and concentrated. The residue waspartitioned between CH₂Cl₂ (500 mL) and saturated NaHCO₃ (300 mL). Theaqueous layer was separated and extracted with CH₂Cl₂ (2×300 mL). Thecombined organic extracts were dried over Na₂SO₄ and concentrated toafford compound VII-l (7.5 g, 91%) as a white solid: ¹H NMR (400 MHz,DMSO-d₆): δ 9.97 (brs, 1H), 8.16 (d, J=8.4 Hz, 1H), 7.95 (d, J=8.6 Hz,1H), 7.52 (ddd, J=8.1, 6.9, 1.2 Hz, 1H), 7.43 (t, J=6.7 Hz, 1H), 7.10(d, J=7.9 Hz, 1H), 6.76 (d, J=7.9 Hz, 1H), 3.62 (t, J=6.8 Hz, 1H), 3.51(s, 3H), 3.37-3.26 (m, 2H), 3.22 (dd, J=14.3, 6.7 Hz, 1H), 3.08 (t,J=14.3, 7.7, Hz, 1H).

Preparation of Compound VII-m

A solution of compound VII-l (7.5 g, 30.6 mmol) in MeOH/H₂O (300 mL/100mL) was charged with NaHCO₃ (25.7 g, 306 mmol) and Boc₂O (10.0 g, 45.9mmol) at 0° C. The resulting mixture was warmed to room temperature andstirred for 1 h. The reaction mixture was partitioned between CH₂Cl₂(200 mL) and water (200 mL). The aqueous layer was separated andextracted with CH₂Cl₂ (2×400 mL). The combined organic extracts werewashed with brine, dried over Na₂SO₄, and concentrated. Flash-columnchromatography using 20% ethyl acetate/hexanes followed by CH₂Cl₂ gavecompound VII-m (9.6 g, 91%) as a white solid: ¹H NMR (300 MHz, CDCl3): δ8.23 (d, J=8.2 Hz, 1H), 7.98 (d, J=8.2 Hz, 1H), 7.57-7.44 (m, 2H), 7.07(d, J=8.0 Hz, 1H), 6.68 (d, J. 7.6 Hz, 1H), 6.55 (brs, 1H), 5.14-4.85(brs, 1H), 4.77-4.51 (m, 1H), 3.78-3.31 (m, 5H), 1.40 (s, 6H), 1.10 (s,3H).

Preparation of Compound VII-n

A solution of compound VII-m (12.9 g, 37.5 mmol) in pyridine (100 mL)was charged with triflate (9.5 mL, 56.3 mmol) at 0° C., and the reactionmixture was stirred at room temperature for 2 h. After concentration,the reaction mixture was partitioned between CH₂Cl₂ (100 mL) and water(50 mL). The aqueous layer was separated and extracted with CH₂Cl₂ (2×50mL). The combined organic extracts were washed with brine, dried overNa₂SO₄, and concentrated to afford compound VII-n (22.0 g, crude) as abrown oil: ¹H NMR (400 MHz, CDCl₃): δ 8.19-8.07 (m, 2H), 7.69-7.64 (m,2H), 7.38 (d, J=8.1 Hz, 1H), 7.28 (d, J=7.9 Hz, 1H), 5.12-5.06 (brs,1H), 4.78-4.67 (m, 1H), 3.68-3.46 (m, 5H), 1.39 (s, 8H), 1.25 (s, 1H).

Preparation of Compound VII-p

A solution of compound VII-n (22.0 g, crude, 37.51 mmol) in anhydrousCH₃CN (250 mL) was charged with TEA (20.5 mL, 150 mmol), 10% (t-Bu)₃P inhexanes (15.0 mL, 7.50 mmol), benzyl but-3-ynylcarbamate (VII-o, 11.3 g,56.3 mmol), and CuI (357 mg, 1.87 mmol) at room temperature. Theresulting mixture was degassed with argon for 10 min and Pd(PPh₃)₄ (4.33mg, 3.75 mmol) was charged rapidly in one portion. After degassing withargon for 5 min, the resulting mixture was refluxed for 16 h. Thereaction mixture was concentrated under vacuum and the residue waspurified by column chromatography (silica gel, 60:40 ethylacetate/hexanes) to afford compound VII-p (14.0 g, 71% over two steps)as a brown oil: ¹H NMR (400 MHz, CDCl₃): δ 8.33 (dd, J=7.5, 2.2 Hz, 1H),8.07 (dd, J=7.5, 2.2 Hz, 1H), 7.58-7.51 (m, 2H), 7.52 (d, J=7.5 Hz, 1H),7.35-7.29 (m, 5H), 7.19 (d, J=7.5 Hz, 1H), 5.16-5.12 (m, 1H), 5.13 (s,2H), 5.07-4.99 (m, 1H), 4.74-4.65 (m, 1H), 3.59 (s, 3H), 3.91-3.42 (m,2H), 3.53 (d, J=6.2 Hz, 2H), 2.79 (t, J=6.4 Hz, 2H), 1.39 (s, 8H), 1.25(s, 1H).

Preparation of Compound VII-q

A solution of methyl ester VII-p (14.0 g, 26.5 mmol) in a mixture of THF(150 mL), methanol (150 mL), and water (75 mL) was charged with solidNaOH (6.33 g, 159 mmol) and the reaction mixture was stirred at roomtemperature for 2 h. When TLC of the reaction mixture showed completionof the reaction, the pH of the reaction mixture was brought to 9-10 byadding 1 N HCl (aqueous) and the organic solvent was removed. The pH ofthe aqueous part was adjusted to 5-6, and the resulting precipitate wasextracted with dichloromethane. The aqueous part was extracted withCH₂Cl₂ (2×50 mL). The organic layers were combined, dried over Na₂SO₄and concentrated to afford compound VII-q (13.0 g, 95%) as a brownsolid: ¹H NMR (400 MHz, DMSO-d₆): 8.32 (d, J=7.4 Hz, 1H), 8.13-8.05 (m,1H), 7.58-7.48 (m, 4H), 7.38-7.29 (m, 5H), 5.21-5.15 (m, 1H), 5.12 (s,2H), 5.07-4.93 (m, 1H), 4.70-4.54 (m, 1H), 3.77-3.62 (m, 1H), 3.57-3.35(m, 2H), 2.84-2.68 (m, 2H), 1.37 (s, 9H).

Preparation of Compound VII-r

A solution of acid VII-q (4.00 g, 7.7 mmol) in THF (100 mL) was cooledto 0° C. in an ice bath. NMM (1.10 mL, 23.2 mmol) was added, followed byPivCl (1.10 mL, 9.30 mmol), and the reaction mixture was stirred at thesame temperature for 2 h. NH₃ (7.0 N in methanol, 11.0 mL, 77.5 mmol)was added and the reaction mixture was stirred at 0° C. for 2 h, broughtto room temperature, and stirred for 16 h. The organic solvent wasremoved. The residue was charged with water and extracted with CH₂Cl₂(3×300 mL). The organic layers were combined, dried over Na₂SO₄,filtered, and concentrated. The residue was purified by columnchromatography (3% methanol in chloroform) to afford amide VII-r (3.50g, 88%) as a light yellow solid: ¹H NMR (400 MHz, DMSO-d6) 8.29 (d,J=7.1 Hz, 1H), 8.21 (d, J=7.0 Hz, 1H), 7.63-7.52 (m, 4H), 7.36-7.30 (m,6H), 6.91 (d, J=7.6 Hz, 1H), 5.05 (s, 2H), 4.23-4.22 (m, 1H), 3.61-3.60(m, 1H), 3.53-3.48 (m, 1H), 3.16-3.06 (m, 1H), 2.74-2.68 (m, 2H), 1.24(s, 9H).

Preparation of Compound VII-s

A suspension of compound VII-r (3.50 g, 6.8 mmol) and 10% Pd/C (700 mg)in EtOH (100 mL) and AcOH (20 mL) was subjected to hydrogenationconditions (1 atm) for 16 h at room temperature. The reaction mixturewas filtered through Celite and washed with EtOH. The filtrate wasconcentrated under vacuum and triturated with MTBE/hexanes to affordacetic salt VII-s (3.0 g, 99%) as an off-white solid: ¹H NMR (400 MHz,DMSO-d6) 8.24-8.21 (m, 1H), 8.10 (d, J=7.0 Hz, 1H), 7.56-7.54 (m, 2H),7.31-7.26 (m, 2H), 4.44-4.42 (m, 1H), 3.75-3.68 (m, 1H), 3.64-3.59 (m,1H), 3.24-3.19 (m, 2H), 3.13 (t, J=6.2 Hz 2H), 2.92 (t, J=6.2 Hz, 2H),1.84-1.71 (m, 4H), 1.39 (s, 9H).

Preparation of Compound VII-t

A solution of amine VII-s (3.0 g, 6.74) in MeOH (100 mL) and water (50mL) was charged with Na₂CO₃ (7.14 g, 67.4 mmol) at 0° C. and stirred for10 min. Benzyl chloroformate (1.93 mL, 13.4 mmol) was added at the sametemperature and the reaction mixture was stirred for 1 h, brought toroom temperature, and stirred for another 1 h. The mixture wasconcentrated, the residue was dissolved in CH₂Cl₂ (200 mL), and thesolution was washed with water (300 mL) and brine (300 mL). The organiclayer was dried over Na₂SO₄, filtered, and concentrated. The residue waspurified by column chromatography (3% methanol in chloroform) to affordamide VII-t (3.10 g, 89%) as a light yellow solid: ESI-MS m/z 520[C₃₀H₃₇N₃O₅+H]⁺.

Preparation of Compound VII-u

Compound VII-t (3.10 g, 5.80 mmol) was dissolved in 4 N HCl in dioxane(40 mL) at room temperature and the solution was stirred for 1 h. Afterconcentration, amine salt VII-u (2.6 g, 99%) was obtained as a whitesolid, and was used directly for the next step: ESI-MS m/z 420[C₂₅H₂₉N₃O₃+H]⁺.

Preparation of Compound 2

A solution of 1 (10 g) in CH₂Cl₂ (100 mL) was cooled to 0° C. After 10min, Dess-Martin periodinane (29 g) was added and the reaction mixturewas stirred at room temperature for 2 h. 1 N NaOH (aqueous) was addedand extracted with CH₂Cl₂ (3×300 mL). The organic layers were combined,dried over Na₂SO₄, filtered, and concentrated to afford aldehyde 2 (8.0g, 80%) as a light yellow liquid.

Preparation of Compound VII-v

A solution of amine salt VII-u (3.70 g, 8.13 mmol), aldehyde (2) (1.7 g,9.75 mmol), and acetic acid (4.88 mL) was added and stirred at roomtemperature for 10 min. Sodium cyanoborohydride (768 mg, 12.2 mmol) wasadded and the mixture stirred for 2 h. Additional 2 (0.3 equiv), AcOH(0.3 equiv), and NaCNBH₃ (0.3 equiv) were charged over 30 min. Thereaction mixture was concentrated to dryness, and the residue was washedwith saturated NaHCO₃ (200 mL) and extracted with EtOAc (3×300 mL). Theorganic layers were dried over Na₂SO₄, filtered, and concentrated. Thiscrude product (VII-v, 8.0 g) was directly used for the next step withoutfurther purification, and product formation was confirmed by LCMS data:ESI-MS m/z 577 [C₃₃H₄₄N₄O₅+H]⁺.

Preparation of Compound VII-w

A solution of amine VII-v (crude product 8.0 g) in MeOH (90 mL) andwater (30 mL) was charged with NaHCO₃ (6.82 g, 81.3 mmol) at 0° C. andstirred for 10 min. Benzyl chloroformate (2.47 mL) was added and thereaction mixture was stirred for 1 h at the same temperature, brought toroom temperature, and stirred for another 1 h. The mixture wasconcentrated, the residue was dissolved in CH₂Cl₂ (200 m L), and thesolution was washed with water (300 mL) and brine (300 mL). The organiclayer was dried over Na₂SO₄, filtered, and concentrated. This crudeproduct VII-w (10.0 g) was directly used for the next step withoutfurther purification, and product formation was confirmed by LCMS data:ESI-MS m/z 711 [C₄₁H₅₀N₄O₇+H]⁺.

Preparation of Compound VII-x

Compound VII-w (crude product, 10.0 g) was dissolved in 4 N HCl indioxane (25 mL) at room temperature and the solution was stirred for 1h. After concentration, amine salt was neutralized with aqueous NaHCO₃.The residue was purified by column chromatography (6% methanol inchloroform) to afford amine VII-x (2.50 g, 50% over three steps) as alight yellow solid: ESI-MS m/z 611 [C₃₆H₄₂N₄O₅+H]⁺.

Preparation of Compounds VII-aa and VII-z

A solution of amine VII-x (2.50 g, 4.09 mmol) in methanol (50 mL) wascharged with triol (VII-y) (4.39 g, 16.4 mmol) and acetic acid (2.45 mL)successively and stirred at room temperature for 10 min. Sodiumcyanoborohydride (1.54 mg, 24.5 mmol) was added and the mixture stirredat room temperature for 24 h. Additional VII-y (2.0 equiv), AcOH (4.0equiv), and NaCNBH₃ (3.0 equiv) were charged and the mixture stirred for48 h. LC/MS showed 90% consumption of amine. Again VII-y (2.0 equiv),AcOH (4.0 equiv), and NaCNBH₃ (3.0 equiv) were added and the mixturestirred for 24 h. The reaction mixture was charged with hexanal (1.46mL, 12.2 mmol) and NaCNBH₃ (1.26 g, 20.0 mmol), stirred for 2 h, andconcentrated to dryness. The residue was washed with saturated NaHCO₃(200 mL), and extracted with EtOAc (3×300 mL). The organic layers weredried over Na₂SO₄, filtered, and concentrated. Purification of compoundsVII-aa and VII-z failed by normal chromatography using CMA system;reverse-phase chromatography using a C18 Gold column was used to getpure VII-z (810 mg, 21%) and VII-aa (1.10 g, 25%) respectively: ESI-MSm/z 947 [C₅₅H₇₀N₄O₁₀+H]⁺; for VII-z and ESI-MS m/z 1115 [C₆₂H₇₄N₄O₁₅+H]⁺for VII-aa.

Preparation of Compound VII-bb

A suspension of VII-aa (1.10 g, 0.98) and 10% Pd/C (200 mg) in a mixtureof EtOH (80 mL) and AcOH (20 mL) was degassed and subjected tohydrogenation conditions (1 atm) for 16 h at room temperature. Thereaction mixture was filtered through a pad of Celite and was washedwith MeOH. The filtrate was concentrated under vacuum to afford aminesalt VII-bb (925 mg, 92%) as a white solid: ESI-MS m/z 847[C₄₆H₆₂N₄O₁₁+H]⁺.

Preparation of Compound VII-dd

A solution of amine salt VII-bb (925 mg, 0.95 mmol) and methyl3,5-diamino-6-chloropyrazine-2-carbonylcarbamimidothioate (VII-cc, 561mg, 1.44 mmol) in EtOH (10 mL) was charged with DIPEA (1.35 mL, 7.60mmol) at room temperature. The reaction mixture was heated at 70° C. ina sealed tube for 2 h, cooled to room temperature, and concentrated invacuo. The residue was purified by column chromatography (silica gel,80:18:2 CHCl₃/CH₃OH/NH₄OH) to afford guanidine VII-dd (500 mg, 50%) as ayellow solid: ¹H NMR (400 MHz, CD₃OD): δ 8.21-8.16 (m, 1H), 8.12-8.07(m, 1H), 7.56-7.49 (m, 2H), 7.45-7.39 (m, 4H), 7.32-7.22 (m, 8H), 5.45(s, 2H), 4.21 (dd, J=10.5, 5.3 Hz, 2H), 3.98-3.89 (m, 4H), 3.83 (dd,J=4.9, 2.5 Hz, 2H), 3.68 (dd, J=9.2, 2.5 Hz, 2H), 3.57 (t, J=10.5 Hz,2H), 3.45-3.37 (m, 2H), 3.27 (t, J=7.7 Hz, 2H), 3.24-3.17 (m, 1H),3.15-3.08 (m, 2H), 2.64-2.44 (m, 6H), 2.43-2.25 (m, 2H), 1.88-1.79 (m,2H), 1.79-1.68 (m, 2H), 1.54-1.41 (m, 2H).

Preparation of the Hydrochloride Salt of3,5-diamino-N—(N-(4-(4-((S)-3-amino-2-(3-(bis((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-3-oxopropyl)naphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide(Compound VII-ee)

4 N aqueous HCl (20 mL) was added to VII-dd (500 mg, 0.48 mmol) and thereaction mixture was stirred at room temperature for 2 h. The solventwas removed and the residue was purified by reverse-phase chromatographyusing a C18 Gold column to afford hydrochloric acid salt VII-ee (285 mg,60%) as a yellow hygroscopic solid: ¹H NMR (400 MHz, DMSO-d₆): δ 10.53(brs, 1H), 10.29 (brs, 1H), 9.46 (brs, 1H), 9.32 (brs, 1H), 9.05-8.78(m, 3H), 8.41-8.33 (m, 1H), 8.17-8.09 (m, 1H), 7.74 (s, 1H), 7.58 (dd,J=6.4, 3.2 Hz, 2H), 7.51 (s, 1H), 7.48-7.35 (m, 1H), 7.32 (d, J=7.8 Hz,1H), 7.28 (d, J=7.3 Hz, 1H), 4.16-4.05 (m, 2H), 4.04-3.96 (m, 1H), 3.84(dd, J=12.8, 3.3 Hz, 1H), 3.72 (d, J=5.8 Hz, 2H), 3.62 (d, J=2.8 Hz,1H), 3.58 (d, J=2.8 Hz, 1H), 3.54-3.45 (m, 4H), 3.44-3.30 (m, 9H),3.28-3.18 (m, 2H), 3.15-3.01 (m, 2H), 2.99-2.85 (m, 2H), 2.28-2.13 (m,2H), 1.81-1.63 (m, 4H).

¹H NMR (400 MHz, CD₃OD): δ 8.25 (dd, J=8.5, 1.7 Hz, 1H), 8.16 (dd,J=8.1, 1.5 Hz, 1H), 7.64-7.54 (m, 2H), 7.37 (ABq, J=7.4 Hz, 2H),4.25-4.17 (m, 3H), 3.88-3.84 (m, 2H), 3.83 (dd, J=13.8, 4.8 Hz, 1H),3.79 (d, J=2.8 Hz, 1H), 3.76 (d, J=2.8 Hz, 1H), 3.73-3.63 (m, 5H),3.61-3.50 (m, 3H), 3.49-3.42 (m, 4H), 3.41-3.35 (m, 3H), 3.23-3.06 (m,4H), 2.36-2.23 (m, 2H), 1.93-1.77 (m, 4H).

Preparation of Compound VIII-b

A suspension of VII-z (800 mg, 0.86) and 10% Pd/C (160 mg) in a mixtureof EtOH (80 mL) and AcOH (20 mL) was degassed and subjected tohydrogenation conditions (1 atm) for 16 h at room temperature. Thereaction mixture was filtered through a pad of Celite and washed withMeOH. The filtrate was concentrated under vacuum to afford amine saltVIII-b (670 mg, 91%) as a white solid: ESI-MS m/z 679 [C₃₉H₅₈N₄O₆+H]⁺.

Preparation of Compound VIII-d

A solution of amine salt VIII-b (670 mg, 0.78 mmol) and methyl3,5-diamino-6-chloropyrazine-2-carbonylcarbamimidothioate (VIII-a, 485mg, 1.24 mmol) in EtOH (10 mL) was charged with DIPEA (1.10 mL, 6.24mmol) at room temperature. The reaction mixture was heated at 70° C. ina sealed tube for 2 h, cooled to room temperature, and concentratedunder vacuum. The residue was purified by column chromatography (silicagel, 80:18:2 CHCl₃/CH₃OH/NH₄OH) to afford guanidine VIII-c (360 mg, 52%)as a yellow solid: ¹H NMR (400 MHz, CD₃OD): δ 8.24-8.18 (m, 1H),8.14-8.07 (m, 1H), 7.56-7.48 (m, 2H), 7.47-7.40 (m, 2H), 7.32-7.22 (m,5H), 5.50 (s, 1H), 4.23 (dd, J=10.8, 5.8 Hz, 1H), 4.00-3.91 (m, 1H),3.86 (dd, J=5.4, 1.9 Hz, 1H), 3.73 (dd, J=9.5, 2.5 Hz, 1H), 3.59 (t,J=10.8 Hz, 2H), 3.46-3.37 (m, 2H), 3.12 (t, J=6.8 Hz, 2H), 3.24-3.17 (m,1H), 2.67 (dd, J=13.8, 4.5 Hz, 1H), 2.55-2.26 (m, 8H), 1.90-1.70 (m,4H), 1.51-1.41 (m, 2H), 1.36-1.08 (m, 9H), 0.86 (t, J=7.2 Hz, 3H).

Preparation of the Hydrochloride Salt of3,5-diamino-N—(N-(4-(4-((S)-3-amino-2-(3-(hexyl((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-3-oxopropyl)naphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide(Compound VIII-d)

4 N aqueous HCl (20 mL) was added to VIII-dc (360 mg, 0.40 mmol) and thereaction mixture was stirred at room temperature for 2 h. The solventwas removed and the residue was purified by reverse-phase chromatographyusing a C18 Gold column to afford hydrochloric acid salt VIII-d (70 mg,36%) as a yellow hygroscopic solid: ¹H NMR (400 MHz, DMSO-d₆): δ 10.52(s, 1H), 10.49-10.28 (m, 1H), 9.72-9.55 (m, 1H), 9.47-9.34 (m, 1H), 9.29(brs, 1H), 9.01-8.74 (m, 2H), 8.43-8.35 (m, 1H), 8.20-8.11 (m, 1H), 7.73(s, 1H), 7.62-7.55 (m, 2H), 7.52 (s, 1H), 7.47-7.37 (m, 2H), 7.32 (d,J=7.1 Hz, 1H), 7.27 (d, J=7.6 Hz, 1H), 3.73-3.67 (m, 2H), 3.60 (dd,J=10.6, 3.0 Hz, 1H), 3.55-3.45 (m, 2H), 3.44-3.22 (m, 3H), 3.31-3.22 (m,3H), 3.20-3.00 (m, 5H), 2.98-2.86 (m, 2H), 2.24-2.08 (m, 2H), 1.79-1.61(m, 6H), 1.36-1.22 (m, 6H), 0.88 (t, J=6.4 Hz, 3H).

¹H NMR (400 MHz, CD₃OD): δ 8.26 (d, J=8.4 Hz, 1H), 8.16 (dd, J=8.1, 1.3Hz, 1H), 7.63-7.54 (m, 2H), 7.37 (q, J=7.2 Hz, 2H), 4.22-4.13 (m, 2H),3.89-3.81 (m, 2H), 3.77 (dd, J=10.6, 3.1 Hz, 1H), 3.73-3.64 (m, 3H),3.55-3.49 (m, 1H), 3.49-3.46 (m, 1H), 3.43-3.34 (m, 6H), 3.27-3.07 (m5H). 2.32-2.17 (m, 2H), 1.93-1.71 (m, 6H), 1.46-1.33 (m, 6H), 0.93 (t,J=6.4 Hz, 3H).

Preparation of Compound IX-b

A suspension of IX-a (5.70 g, 11.0 mmol) and 10% Lindlar's Catalyst (1.0g) in EtOH (100 mL) and THF (20 mL) was subjected to hydrogenationconditions (1 atm) for 36 h at room temperature. The reaction mixturewas filtered through a plug of diatomaceous earth and the plug waswashed with MeOH. The filtrate was concentrated in vacuum and theresidue was purified by column chromatography (silica gel, 95:5CHCl₃/CH₃OH) to afford compound IX-b (5.20 g, 92%) as a yellow solid:ESI-MS m/z 518 [C₃₀H₃₅N₃O₅+H]⁺.

Preparation of Compound IX-c

Compound IX-b (5.20 g, 10.0 mmol) was dissolved in 4 N HCl in dioxane(40 mL) at room temperature and the solution was stirred for 2 h. Afterconcentrated, amine salt IX-c (4.50 g, 99%) was obtained as a whitesolid: ESI-MS m/z 418 [C₂₅H₂₇N₃O₃+H]⁺ 419.

Preparation of tert-butyl 3-oxopropylcarbamate 2

A solution of 1 (10 g) in CH₂Cl₂ (100 mL) was cooled to −0° C. and after10 min Dess-Martin Periodane (29 g) was added and reaction mixture wasstirred at the room temperature for 2 h. 1 N NaOH (aqueous) was addedand extracted with CH₂Cl₂ (3×300 mL). The organic layers were combined,dried over Na₂SO₄, filtered, and concentrated to afford aldehyde 2 (9.0g, 91%) as a light yellow liquid and directly used for next step.

Preparation of Compound IX-d

To a solution of amine salt IX-c (4.50 g, 10.0 mmol) in methanol (100mL), aldehyde (2) (2.0 g, 12.0 mmol) acetic acid (6.0 mL) was added andstirred at rt for 10 min then sodium cyanoborohydride (942 mg, 15.0mmol) was added and stirred at room temperature for 2 h. Additional 2(0.3 equiv), AcOH (0.5 equiv), NaCNBH₃ (0.5 equiv) were added over theperiod of 2 h and this addition was repeated for three times until LC-MSshowed >90% consumption of amine. The reaction mixture was concentratedto dryness, the residue was washed with saturated NaHCO₃ (200 mL), andextracted with EtOAc (3×300 mL). The organic layers were dried overNa₂SO₄, filtered, concentrated. The crude product IX-d (8.0 g) wasconfirmed by LC-MS analysis and directly used for the next step withoutfurther purification: ESI-MS m/z 575 [C₃₃H₄₂N₄O₅+H]⁺.

Preparation of Compound IX-e

To a solution of amine IX-d (crude product 8.0 g) in MeOH (150 mL) andwater (50 mL) was added NaHCO₃ (8.40 g, 100 mmol) at 0° C. and stirredfor 10 min, then benzyl chloroformate (3.0 mL, 20.0 mmol) was addeddropwise at same temperature and the reaction mixture was stirred for 2h at same temperature then brought to room temperature and stirred foranother 1 h. The mixture was concentrated, the residue was dissolved inCH₂Cl₂ (200 mL), and the solution was washed with water (300 mL) andbrine (300 mL). The organic layer was dried over Na₂SO₄, filtered, andconcentrated. This crude product IX-e (18.0 g) was confirmed by LC-MSanalysis and directly used for the next step without furtherpurification: ESI-MS m/z 709 [C₄₁H₄₈N₄O₇+H]⁺.

Preparation of Compound IX-f

Compound IX-e (crude product, 18.0 g) was dissolved in 4 N HCl indioxane (50 mL) at room temperature and the solution was stirred for 2h. After concentrated, amine salt was neutralized with aqueous NaHCO₃.The residue was purified by column chromatography (6% methanol inchloroform) to afford amine IX-f (2.50 g, 41% over three steps) as alight yellow solid: ESI-MS m/z 609 [C₃₆H₄₀N₄O₅+H]⁺.

Preparation of Compound IX-h and IX-i

To a solution of amine IX-f (2.50 g, 4.10 mmol) in methanol (100 mL),triol (IX-g) (3.30 g, 12.3 mmol), acetic acid (2.46 mL) were addedsuccessively and stirred at rt for 10 min then sodium cyanoborohydride(1.30 g, 20.5 mmol) were added and stirred at room temperature for 16 h.Additional IX-g (2.0 equiv), AcOH (5.0 equiv), NaCNBH₃ (3.0 equiv) wereadded over the period of 16 h and this addition was repeated for anothertime and stirred for 16 h, To this reaction mixture, hexanal (1.47 mL,12.3 mmol), AcOH (0.7 mL), NaCNBH₃ (774 mg) were added and stirred for 1h, The reaction mixture was concentrated to dryness, the residue waswashed with saturated NaHCO₃ (200 mL), and extracted with EtOAc (3×300mL). The organic layers were dried over Na₂SO₄, filtered, concentrated.Purification of compounds IX-h and IX-i were failed by normalchromatography using CMA system, then reverse phase column using C-18gold was used to afford pure IX-h (1.30 g, 34%) and IX-i (1.43 g, 28%)respectively: ESI-MS m/z 945 [C₅₅H₆₈N₄O₁₀+H]⁺ for IX-h and ESI-MS m/z1113 [C₆₂H₇₂N₄O₁₅+H]⁺ for IX-i.

Preparation of Compound IX-j

A suspension of IX-h (1.3 g, 1.37) and 10% Pd/C (400 mg) in a mixture ofEtOH (100 mL) and AcOH (30 mL) was degassed and then subjected tohydrogenation conditions (1 atm) for 16 h at room temperature. Thereaction mixture was filtered through a plug of diatomaceous earth andthe plug was washed with MeOH. The filtrate was concentrated in vacuumto afford amine salt IX-j (1.15 g, 98%) as a white solid: ESI-MS m/z 679[C₃₉H₅₈N₄O₆+H]⁺ 679.

Preparation of Compound IX-l

To a solution of amine salt IX-j (1.15 g, 1.34 mmol) and methyl3,5-diamino-6-chloropyrazine-2-carbonylcarbamimidothioate (IX-k, 834 mg,2.14 mmol) in EtOH (20 mL) was added DIPEA (1.90 mL, 10.72 mmol) at roomtemperature. The reaction mixture was heated at 70° C. in a sealed tubefor 2 h, then cooled to room temperature, and concentrated in vacuo. Theresidue was purified by column chromatography (silica gel, 80:18:2CHCl₃/CH₃OH/NH₄OH) to afford guanidine IX-l (800 mg, 67%) as a yellowsolid: ¹H NMR (400 MHz, CD₃OD): δ 7.72 (dd, J=8.3, 2.7 Hz, 2H), 7.62 (d,J=8.6 Hz, 2H), 7.44 (d, J=7.4, 3.9 Hz, 2H), 7.38-7.32 (m, 2H), 7.32-7.27(m, 3H), 5.51 (s, 1H), 4.25 (dd, J=10.8, 5.8 Hz, 1H), 4.04-3.93 (m, 2H),3.89 (dd, J=5.3, 1.7 Hz, 1H), 3.74 (dd, J=9.2, 2.0 Hz, 1H), 3.61 (t,J=11.0 Hz, 1H), 3.45 (t, J=7.1 Hz, 1H), 3.17-3.05 (m, 1H), 2.95 (dd,J=13.8, 7.4 Hz, 1H), 2.83 (t, J=7.1 Hz, 2H), 2.80-2.69 (m, 3H),2.67-2.56 (m, 2H), 2.54-2.44 (m, 3H), 1.87-1.78 (m, 2H), 1.76-1.67 (m,2H), 1.64-1.54 (m, 2H), 1.36-1.17 (m, 6H), 1.16-1.01 (m, 4H), 0.85 (t,J=7.3 Hz, 3H).

Preparation of the Hydrochloride Salt of3,5-diamino-N—(N-(4-(6-((S)-3-amino-2-(3-(hexyl((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-3-oxopropyl)naphthalen-2-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide(Compound IX-m)

4 N aq HCl (25 mL) was added to IX-l (800 mg, 0.89 mmol) and reactionmixture was stirred at room temperature for 2 h. The solvent was removedthe residue was purified by reverse phase column using C-18 Gold columnto afford hydrochloric acid salt IX-m (500 mg, 62%) as a yellowhygroscopic solid: ¹H NMR (400 MHz, DMSO-d₆) 10.51 (brs, 1H), 9.29 (brs,1H), 8.94 (brs, 1H), 8.82 (brs, 1H), 7.77 (dd, J=8.7, 3.1 Hz, 2H), 7.68(d, J=10.7 Hz, 2H), 7.59 (brs, 1H), 7.47-7.34 (m, 4H), 7.17 (brs, 1H),5.97-5.09 (m 3H), 4.64 (brs, 1H), 4.44 (brs, 1H), 3.96 (brs, 1H), 3.69(d, J=11.1 Hz, 1H), 3.56-3.49 (m, 1H), 3.48-3.40 (m, 2H), 3.17-2.90 (m,6H), 2.84-2.66 (m, 1H), 2.78 (t, J=7.5 Hz, 2H), 1.75-1.67 (m, 2H),1.65-1.55 (m, 2H), 1.30-1.07 (m, 6H), 0.85 (t, J=7.2 Hz, 3H).

¹H NMR (400 MHz, CD₃OD) 7.77 (d, J=8.5 Hz, 2H), 7.70 (s, 1H), 7.65 (s,1H), 7.40 (dt, J=8.6, 1.7 Hz, 2H), 4.15-4.08 (m, 1H), 3.83-3.77 (m, 2H),3.76-3.64 (m, 4H), 3.37 (t, J=7.1 Hz, 2H), 3.24 (d, J=10.6 Hz, 2H),3.20-3.08 (m, 4H), 2.85 (t, J=7.4 Hz, 2H), 2.97-2.76 (m, 5H), 1.95-1.80(m, 4H), 1.79-1.70 (m, 2H), 1.55 (brs, 1H), 1.35-1.12 (m, 6H), 1.45-1.36(m, 1H), 0.90 (t, J=7.1 Hz, 3H).

Preparation of Compound X-b

A suspension of X-a (1.43 g, 1.28) and 10% Pd/C (400 mg) in a mixture ofEtOH (100 mL) and AcOH (40 mL) was degassed and then subjected tohydrogenation conditions (1 atm) for 16 h at room temperature. Thereaction mixture was filtered through a plug of diatomaceous earth andthe plug was washed with MeOH. The filtrate was concentrated in vacuumto afford amine salt X-b (1.30 g, 99%) as a white solid: ESI-MS m/z 847[C₄₆H₆₂N₄O₁₁+H]⁺.

Preparation of Compound X-c

To a solution of amine salt X-b (1.30 g, 1.26 mmol) and methyl3,5-diamino-6-chloropyrazine-2-carbonylcarbamimidothioate (X-e, 788 mg,2.02 mmol) in EtOH (20 mL) was added DIPEA (1.79 mL, 10.0 mmol) at roomtemperature. The reaction mixture was heated at 70° C. in a sealed tubefor 2 h, then cooled to room temperature, and concentrated in vacuo. Theresidue was purified by column chromatography (silica gel, 80:18:2CHCl₃/CH₃OH/NH₄OH) to afford guanidine X-c (900 mg, 68%) as a yellowsolid: ¹H NMR (400 MHz, CD₃OD): δ 7.70 (d, J=8.1 Hz, 2H), 7.59 (s, 2H),7.46-7.39 (m, 4H), 7.34-7.24 (m, 8H), 5.45 (s, 2H), 4.21 (dd, J=10.7,5.5 Hz, 2H), 3.99-3.88 (m, 6H), 3.82 (dd, J=5.3, 2.4 Hz, 2H), 3.67 (dd,J=9.8, 2.9 Hz, 2H), 3.57 (t, J=10.6, 2H), 3.23 (t, J=6.7 Hz, 2H), 3.06(dd, J=13.4, 6.6 Hz, 1H), 2.93 (dd, J=13.6, 7.5 Hz, 1H), 2.79 (t, J=7.6Hz, 2H), 2.63-2.45 (m, 5H), 2.44-2.36 (m, 2H), 1.84-1.73 (m, 2H),1.70-1.60 (m, 2H), 1.57-1.44 (m, 2H).

Preparation of the Hydrochloride Salt of3,5-diamino-N—(N-(4-(6-((S)-3-amino-2-(3-(bis((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-3-oxopropyl)naphthalen-2-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide(Compound X-d)

4 N aq HCl (30 mL) was added to X-c (900 mg, 0.85 mmol) and reactionmixture was stirred at room temperature for 2 h. The solvent was removedthe residue was purified by reverse phase column using C-18 Gold columnto afford hydrochloric acid salt X-d (590 mg, 70%) as a yellowhygroscopic solid: ¹H NMR (400 MHz, DMSO-d₆) 10.51 (brs, 1H), 9.81 (brs,1H), 9.29 (brs, 1H), 8.94 (brs, 1H), 8.83 (brs, 1H), 7.94 (brs, 1H),7.80 (brs, 1H), 7.78 (brs, 1H), 7.71 (brs, 1H), 7.68 (brs, 1H), 7.59(brs, 1H), 7.46-7.35 (m, 4H). 5.47 (brs, 2H), 4.84 (brs, 1H), 4.69-4.54(m, 3H), 4.43 (brs, 1H), 4.18-3.98 (m, 3H), 3.74-3.67 (m, 2H), 3.63-3.61(m, 1H), 3.60-3.56 (m, 1H), 3.55-3.38 (m, 6H), 3.27-3.09 (m, 3H),3.02-2.86 (m, 2H), 2.79 (t, J=7.1 Hz, 2H), 2.25-2.09 (m, 2H), 1.79-1.67(m, 2H), 1.65-1.54 (m, 2H).

¹H NMR (400 MHz, CD₃OD) 7.79 (brs, 1H), 7.77 (brs, 1H), 7.74 (brs, 1H),7.66 (brs, 1H), 7.40 (dt, J=6.8, 1.6 Hz, 2H), 4.24-4.12 (m, 3H),3.86-3.82 (m, 2H), 3.80 (d, J=3.2 Hz, 1H), 3.77 (d, J=3.4 Hz, 1H),3.74-3.63 (m, 6H0, 3.52-3.33 (m, 6H), 3.36 (t, J=6.9 Hz, 2H), 3.28-3.21(m, 2H), 3.15-3.07 (m, 2H), 2.86 (t, J=7.1 Hz, 2H), 2.28-2.04 (m, 2H),1.90-1.80 (m, 2H), 1.79-1.70 (m, 2H).

Preparation of 1,4-tetralinyl tyrosine derivatives

Preparation of Compound XI-c

TEA (340 mL) was added slowly to formic acid (150 mL) at 0° C. After theaddition of TEA, compound XI-a (76.4 g, 401.6 mmol) and compound XI-b(59.2 g, 415.0 mL) were added. The reaction mixture was heated to refluxfor 12 h, cooled down to room temperature, and poured into ice water(600 mL). The pH of the solution was adjusted to 11 by the addition ofaqueous NaOH (70 g) in water (1.4 L). The resulting solution wasextracted with EtOAc (600 mL for 3 times) and acidified to pH 2-3. Thewhite precipitate was filtered and dried under vacuum at 50° C. toafford compound XI-c (74.6 g, 79%) as an off-white solid. ¹H NMR (400MHz, MeOD-d₄): δ 6.92 (d, J=8.4 Hz, 1H), 6.67 (dd, J=8.4 Hz, 8.4 Hz,1H), 3.75 (s, 3H), 2.81 (t, J=7.6 Hz, 2H), 2.67 (t, J=6.0 Hz, 2H), 2.62(t, J=6.0 Hz, 2H), 2.49 (t, J=7.6 Hz, 2H), 1.78-1.73 (m, 4H).

Preparation of Compound XI-e

A solution of compound XI-c (36 g, 153.8 mmol) in dry THF (400 mL) wascharged with TEA (56 mL, 400.0 mmol) and pivaloyl chloride (22.7 mL,184.6 mmol) dropwise at −10° C. The mixture was stirred for 40 min at−10° C. followed by the addition of compound XI-d (32.7 g, 184.6 mmol)and the solution of LiCl (8.5 g, 184.6 mmol) in THF (200 mL). Thereaction mixture was warmed to room temperature, stirred for 12 h,quenched with saturated NaHCO₃, concentrated to remove THF, andpartitioned between EtOAc (1000 mL) and water (1000 mL). The aqueouslayer was separated and extracted with EtOAc (2×800 mL). The combinedorganic extracts were washed with brine, dried over Na₂SO₄ andconcentrated. The residue was recrystallized from EtOAc/hexane (3:1,V/V) to afford compound XI-e (40.7 g, 78%) as a white solid. ¹H NMR (400MHz, CDCl₃): δ 7.32-7.25 (m, 3H), 7.20 (d, J=8.0 Hz, 1H), 7.02 (d, J=8.0Hz, 1H), 6.63 (d, J=8.0 Hz, 1H), 4.68-4.62 (m, 1H), 4.18-4.16 (m, 2H),3.79 (s, 3H), 3.31 (dd, J=13.6, 3.2 Hz, 1H), 3.23-3.16 (m, 2H),2.95-2.91 (m, 2H), 2.78-2.71 (m, 3H), 2.66 (t, J=7.5 Hz, 2H), 1.80-1.75(m, 4H).

Preparation of Compound XI-f

A solution of compound XI-e (25.0 g, 63.5 mmol) in dry THF (500 mL) wascharged with KHMDS (18.0 g, 95.3 mmol) portionwise at −78° C. After theresulting mixture was stirred for 30 min, trisyl azide (25.0 g, 82.6mmol) was added and the reaction mixture was stirred for 2-3 min. Aceticacid (19.1 g, 317.5 mmol) was added at the same temperature, followed bypotassium acetate (31.0 g, 317.5 mmol). The reaction mixture was warmedto 27° C., stirred for 16 h, and quenched with brine (500 mL). Theaqueous layer was separated and extracted with EtOAc (3×500 mL). Thecombined organic extracts were washed with saturated NaHCO₃ and brine,dried over Na₂SO₄, and concentrated. The residue was purified by columnchromatography (silica gel, 90:10 hexane/EtOAc) to afford compound XI-f(15.0 g, 60%) as a colorless oil. ¹H NMR (400 MHz, CDCl₃): δ 7.34-7.28(m, 3H), 7.25-7.20 (m, 2H), 7.01 (d, J=8.4 Hz, 1H), 6.61 (d, J=8.4 Hz,1H), 5.36 (t, J=7.6 Hz, 1H), 4.55-4.45 (m, 1H), 4.10 (dd, J=9.2, 2.4 Hz,1H), 3.94 (t, J=8.4 Hz, 1H), 3.78 (s, 3H), 3.30 (dd, J=11.2, 3.2 Hz,1H), 3.12 (dd, J=8.0, 2.4 Hz, 2H), 2.81-2.72 (m, 3H), 2.63 (t, J=6.4 Hz,2H), 1.80-1.73 (m, 4H).

Preparation of Compound XI-g

A solution of compound XI-f (22.0 g, 50.6 mmol) in THF/H₂O (450 mL/150mL) was charged with H₂O₂ (25 mL, 253 mmol) followed by LiOH (4.7 g, 111mmol) portionwise at 0° C. The reaction mixture was stirred for 3 h atthe same temperature, quenched with saturated Na₂SO₃ (300 mL),concentrated under reduced pressure to remove THF, and washed withCH₂Cl₂ (200 mL). The aqueous layer was acidified with 2 N aqueous HCland extracted with CH₂Cl₂ (2×250 mL). The combined organic extracts weredried over Na₂SO₄ and concentrated to afford compound XI-g (11.0 g, 79%)as an off-white solid. The crude product was directly used for the nextstep without purification.

Preparation of Compound XI-h

A suspension of compound XI-g (10.0 g, 36.3 mmol) and 10% Pd/C (3.50 g)in AcOH/H₂O (200 mL/50 mL) was subjected to hydrogenation conditions (1atm) for 12 h at room temperature. The reaction mixture was filteredthrough celite and washed with MeOH. The filtrate was concentrated undervacuum to afford acetic salt XI-h (8.0 g, 88%) as a yellow solid. Thecrude product was directly used for the next step without purification.

Preparation of Compound XI-i

A solution of compound XI-h (13.0 g, 52.3 mmol) in acetic acid (150 mL)was charged with 40% hydrobromic acid (150 mL) dropwise at roomtemperature and the reaction mixture was refluxed for 4 h. The reactionmixture was cooled to room temperature and concentrated. The residue wasdiluted with H₂O (15 mL), slightly basified with ammonia andcrystallized overnight to afford compound XI-i (15.0 g, 90%) as a brownsolid. The product was characterized by LC/MS and used for the next stepwithout purification. ESI-MS m/z 236 [C₁₃H₁₇NO₃+H]⁺.

Preparation of Compound XI-j

Acetyl chloride (26.0 g, 332 mmol) was added to dry methanol (210 mL) at0° C. followed by compound XI-i (15.0 g, 47.4 mmol). The reactionmixture was refluxed for 4 h and concentrated. The residue waspartitioned between CH₂Cl₂ (300 mL) and saturated NaHCO₃ (300 mL). Theaqueous layer was separated and extracted with CH₂Cl₂ (2×300 mL). Thecombined organic extracts were dried over Na₂SO₄ and concentrated toafford compound XI-j (15.0 g, crude) as colorless oil. The crude productwas characterized by LC/MS and used for the next step withoutpurification. ESI-MS m/z 250 [C₁₄H₁₉NO₃+H]⁺.

Preparation of Compound XI-k

A solution of compound XI-j (15.0 g, 47.0 mmol) in MeOH/H₂O (160 mL/160mL) was charged with NaHCO₃ (17.0 g, 200.0 mmol) and Boc₂O (12.8 g, 60.0mmol) at 0° C. The resulting mixture was allowed to warm to roomtemperature and stirred for 3 h. The reaction mixture was partitionedbetween CH₂Cl₂ (200 mL) and water (200 mL). The aqueous layer wasseparated and extracted with CH₂Cl₂ (2×200 mL). The combined organicextracts were washed with brine, dried over Na₂SO₄, and concentrated togive compound XI-k (9.0 g, 50% over three steps from compound XI-h) as acolorless oil. ¹H NMR (400 MHz, CDCl₃): δ 6.77 (d, J=8.4 Hz, 1H), 6.55(d, J=8.4 Hz, 1H), 4.95 (d, J=8.0 Hz, 1H), 4.70 (s, 1H), 4.50 (t, J=6.5Hz, 1H), 3.69 (s, 3H), 3.42 (dd, J=14.0, 6.0 Hz, 1H), 2.89-2.84 (m, 1H),2.68-2.63 (m, 4H), 1.79 (t, J=3.2 Hz, 4H), 1.40 (s, 9H).

Preparation of Compound XI-l

A solution of compound XI-k (9.40 g, 26.9 mmol) in pyridine (100 mL) wascharged with triflate (11.4 g, 40.4 mmol) at 0° C., and the reactionmixture was stirred at room temperature for 2 h. After concentration,the reaction mixture was partitioned between CH₂Cl₂ (300 mL) and water(300 mL). The aqueous layer was separated and extracted with CH₂Cl₂(2×300 mL). The combined organic extracts were washed with brine, driedover Na₂SO₄, and concentrated to afford compound XI-l (9.10 g, 71%) as abrown oil. ¹H NMR and LC-MS data is consistent with product. ¹H NMR (400MHz, CDCl₃): δ 7.29-7.26 (m, 2H), 5.04 (d, J=7.8 Hz, 1H), 4.56 (d, J=7.2Hz, 1H), 3.68 (s, 3H), 3.12-3.04 (m, 1H), 2.95-2.90 (m, 1H), 2.80-2.73(m, 4H), 1.83-1.79 (m, 4H), 1.38 (s, 9H).

Preparation of Compound XI-n

A solution of compound XI-l (9.10 g, 18.9 mmol) in anhydrous CH₃CN (100mL) was charged with TEA (7.6 g, 75.6 mmol), (t-Bu)₃P in hexanes (0.76g, 3.78 mmol), benzyl but-3-ynylcarbamate (XI-m, 5.74 g, 28.3 mmol), andCuI (180 mg, 0.94 mmol) at room temperature. The resulting mixture wasdegassed with argon for 3 min and Pd(PPh₃)₄ (2.18 g, 1.89 mmol) wasadded rapidly in one portion. After degassing with argon for 5 min, theresulting mixture was refluxed for 4 h. The reaction mixture wasconcentrated under vacuum and the residue was purified by column toafford compound XI-n (7.50 g, 74% over two steps) as a brown oil. ¹H NMRand LC-MS data is consistent with product. ¹H NMR (300 MHz, CDCl₃): δ7.36-7.25 (m, 5H), 7.15 (d, J=7.8 Hz, 1H), 6.83 (d, J=7.8 Hz, 1H), 5.12(br s, 3H), 4.97 (d, J=7.6 Hz, 1H), 4.52 (d, J=6.8 Hz, 1H), 3.67 (s,3H), 3.46-3.40 (m, 2H), 3.11-3.04 (m, 1H), 2.95-2.83 (m, 3H), 2.68-2.64(m, 4H), 1.77-1.75 (m, 4H), 1.39 (s, 9H).

Preparation of Compound XI-o

A solution of methyl ester XI-n (7.50 g, 14.04 mmol) in THF/MeOH/H₂O (50mL/50 mL/25 mL) was charged with NaOH (1.12 g, 28.08 mmol) and thereaction mixture was stirred at room temperature for 1 h. The pH valuewas adjusted to 9 with 1 N aqueous HCl and the organic solvent wasremoved. The pH value of the residue was adjusted to 5, and thesuspension was partitioned between CH₂Cl₂ (200 mL) and water (200 mL).The aqueous layer was separated and extracted with CH₂Cl₂ (2×200 mL).The combined organic extracts were dried over Na₂SO₄ and concentrated toafford compound XI-o (6.50 g, 90%) as a brown solid. ¹H NMR (400 MHz,DMSO-d₆): δ 7.44 (t, J=5.8 Hz, 1H), 7.33-7.28 (m, 5H), 7.15 (d, J=8.4Hz, 1H), 7.09 (d, J=7.8 Hz, 1H), 6.99 (d, J=7.8 Hz, 1H), 5.02 (br s,2H), 4.07-4.01 (m, 1H), 3.61-3.58 (m, 1H), 3.24-3.15 (m, 2H), 3.02-2.97(m, 1H), 2.79-2.75 (m, 3H), 2.66-2.64 (m, 2H), 2.58 (t, J=7.0, Hz, 2H),1.73-1.69 (m, 4H), 1.31 (s, 9H).

Preparation of Compound XI-p

A solution of acid XI-o (6.50 g, 12.5 mmol) in THF (200 mL) was chargedwith NMM (1.89 g, 18.75 mmol) and i-BCF (2.04 g, 15.0 mmol) at 0° C. Thereaction mixture was stirred at the same temperature for 1 h and NH₃(7.0 N in methanol, 29.4 mL, 206 mmol) was added dropwise. The reactionmixture continued to stir at 0° C. for 2 h, warmed to room temperature,and stirred for 1 h. After concentration, the residue was partitionedbetween CH₂Cl₂ (100 mL) and water (100 mL). The aqueous layer wasseparated and extracted with CH₂Cl₂ (2×100 mL). The combined organicextracts were dried over Na₂SO₄ and concentrated. The residue was washedwith MTBE to afford amide XI-p (5.90 g, 70%) as a yellow solid. ¹H NMR(400 MHz, DMSO-d₆): δ 7.44 (t, J=5.8 Hz, 1H), 7.33-7.28 (m, 5H), 7.15(d, J=8.4 Hz, 1H), 7.09 (d, J=7.8 Hz, 1H), 6.99 (d, J=7.8 Hz, 1H), 5.02(s, 2H), 4.12-4.05 (m, 1H), 3.62-3.53 (m, 1H), 3.25-3.13 (m, 3H),2.94-2.88 (m, 1H), 2.74-2.67 (m, 4H), 2.60 (t, J=7.0, Hz, 2H), 1.74-1.69(m, 4H), 1.31 (s, 9H).

Preparation of Compound XI-q

A suspension of compound XI-p (5.90 g, 11.3 mmol) and 10% Pd/C (59 mg)in EtOH (100 mL)/AcOH (20 mL) was subjected to hydrogenation conditions(1 atm) for 16 h at room temperature. The reaction mixture was filteredthrough celite and washed with EtOH. The filtrate was concentrated undervacuum and washed with MTBE/hexanes to afford acetic salt XI-q (6.50 g,crude) as a colorless liquid. ESI-MS m/z 390 [C₂₂H₃₅N₃O₃+H]⁺.

Preparation of Compound XI-r

A stirred solution of compound XI-q (6.50 g, crude) in MeOH (300mL)/water (100 mL) was charged with Na₂CO₃ and CbzCl (4.20 g, 25.06mmol) at 0° C. and stirred at the same temperature for 1 h. The reactionmixture was stirred for 1 h at room temperature and the solvent wasremoved and partitioned between CH₂Cl₂ (500 mL) and water (100 mL). Theaqueous layer was separated and extracted with CH₂Cl₂ (2×100 mL). Thecombined organic extracts were washed with brine, dried over Na₂SO₄, andconcentrated to afford compound XI-r (3.90 g, 66% over two steps) as ayellow solid. ¹H NMR (300 MHz, CDCl₃): δ 7.37-7.32 (m, 5H), 6.96-6.89(m, 2H), 5.65 (br s, 1H), 5.29 (br s, 1H), 5.08 (s, 2H), 4.71-4.69 (m,1H), 4.31-4.28 (m, 1H), 3.21 (t, J=6.2 Hz, 2H), 3.11-2.95 (m, 2H), 2.74(br s, 2H), 2.67 (br s, 2H), 2.54 (br s, 2H), 1.73-1.69 (m, 4H), 1.40(s, 9H).

Preparation of Compound XI-s

A solution of compound XI-r (3.90 g, 7.45 mmol) in dioxane was chargedwith 4 N HCl in dioxane (30 mL) and the reaction mixture was stirred for4 h at room temperature. The solvent was removed under vacuum and theresidue was washed with MTBE to afford compound XI-s (3.0 g, 95%) as ayellow oil. ¹H NMR (300 MHz, CD₃OD): δ 7.33-7.25 (m, 5H), 7.00-6.97 (m,2H), 5.05 (s, 2H), 4.00-3.92 (m, 1H), 3.20-2.98 (m, 4H), 2.77-2.65 (m,4H), 2.57 (br s, 2H), 1.81-1.77 (m, 4H), 1.55-1.54 (m, 4H).

Preparation of Compound XI-t

A solution of compound XI-s (3.0 g, 7.09 mmol) and aldehyde 2 (1.47 g,8.51 mmol) in MeOH (100 mL) was charged with acetic acid (5.0 mL) andthe reaction mixture was stirred at room temperature for 10 min. Sodiumcyanoborohydride (670 mg, 10.63 mmol) was added and the solutioncontinued to stir at room temperature for 1 h. Additional compound 2(0.3 equiv), AcOH (0.5 equiv), and NaCNBH₃ (0.5 equiv) were added andstirred for 1 h. After concentration, the residue was partitionedbetween EtOAc (300 mL) and saturated NaHCO₃ (200 mL). The aqueous layerwas separated and extracted with EtOAc (2×300 mL). The combined organicextracts were dried over Na₂SO₄ and concentrated. The residue XI-t (3.50g, crude) was directly used for the next step without furtherpurification.

Preparation of Compound XI-u

A solution of compound XI-t [3.50 g, crude in MeOH/H₂O (100 mL/50 mL)]was charged with saturated Na₂CO₃ at 0° C. and the solution was stirredfor 10 min. Benzyl chloroformate (1.53 g, 9.05 mmol) was added dropwiseand the reaction mixture was stirred for 1 h at 0° C., warmed to roomtemperature, and stirred for 1 h. After concentration, the residue wasdissolved in CH₂Cl₂ (200 mL), then washed with water (300 mL) and brine(300 mL). The organic layer was dried over Na₂SO₄ and concentrated andpurified by column to afford XI-u (3.20 g, 65% over two steps) as ayellow oil. ¹H NMR (300 MHz, CD₃OD): δ 7.32-7.26 (m, 13H), 6.91-6.73 (m,3H), 5.15-4.95 (m, 4H), 4.48-4.31 (m, 1H), 3.63-3.51 (m, 1H), 3.17-3.03(m, 9H), 2.87-2.67 (m, 4H), 2.57 (br s, 7H), 1.76-1.63 (m, 7H),1.53-1.52 (m, 6H), 1.48-1.39 (br s, 20H).

Preparation of Compound XI-v

Compound XI-u (3.20 g, 4.48 mmol) was dissolved in 4 N HCl in dioxane(50 mL) at room temperature and the solution was stirred for 2 h. Afterconcentration, the residue was washed with MTBE to afford compound XI-v(2.50 g, 92%) as an off-white solid. ¹H NMR (300 MHz, CD₃OD): δ7.33-7.28 (m, 9H), 6.92-6.73 (m, 2H), 5.12-4.99 (m, 4H), 4.57-4.52 (m,1H), 3.71-3.60 (m, 1H), 3.20-3.03 (m, 7H), 2.81-2.53 (m, 8H), 1.89-1.71(m, 6H), 1.53 (br s, 4H).

Preparation of Compounds XI-x and XI-y

A solution of compound XI-v (2.50 g, 4.07 mmol) and triol XI-w (2.18 g,8.14 mmol) in methanol (10 mL) was charged with acetic acid (2.5 mL) andthe reaction mixture was stirred at room temperature for 10 min. Sodiumcyanoborohydride (370 mg, 6.15 mmol) was added and the solutioncontinued to stir at room temperature for 24 h. Additional compound XI-w(2.0 equiv), AcOH (10 equiv), and NaCNBH₃ (1.5 equiv) were added and thesolution continued to stir at room temperature for 24 h. Hexanal (2.00mL, 20.3 mmol), AcOH (1.10 mL), and NaCNBH₃ (370 mg, 6.15 mmol) wereadded and the reaction mixture was stirred for 2 h. After concentration,the residue was partitioned between EtOAc (300 mL) and saturated NaHCO₃(200 mL). The aqueous layer was separated and extracted with EtOAc(2×300 mL). The combined organic extracts were dried over Na₂SO₄ andconcentrated. The residue was purified by C18 reverse phase Gold columnto afford compound XI-x (310 mg, 7%) and compound XI-y (510 mg, 14%) aswhite solids. ¹H NMR for compound XI-x (400 MHz, CD₃OD): δ 7.44 (br s,5H), 7.32-7.28 (m, 16H), 6.83-6.77 (m, 2H), 5.53-5.45 (m, 2H), 5.18-5.04(m, 4H), 4.45 (br s, 1H), 4.23-4.14 (m, 2H), 3.97-3.91 (m, 6H), 3.83 (brs, 6H), 3.69 (br s, 2H), 3.58 (t, J=8.0 Hz, 2H), 3.17-3.04 (m, 5H),2.76-2.51 (m, 12H), 1.79-1.64 (m, 4H), 1.50 (br s, 6H). ¹H NMR forcompound XI-y (400 MHz, CD₃OD): δ 7.45 (br s, 2H), 7.34-7.26 (m, 14H),6.79-6.75 (m, 2H), 5.50 (br s, 1H), 5.05 (m, 4H), 4.55-4.44 (m, 1H),4.25-4.21 (m, 1H), 3.98-3.92 (m, 3H), 3.75-3.57 (m, 3H), 3.20-3.29 (m,6H), 2.66-2.45 (m, 10H), 1.75-1.67 (m, 5H), 1.53 (br s, 6H), 1.28-1.18(m, 10H), 0.86 (t, J=7.0 Hz, 3H).

Preparation of Compound XI-z

A suspension of XI-x (310 mg, 0.273 mmol) and 10% Pd/C (30 mg) inEtOH/AcOH (50 mL/10 mL) was subjected to hydrogenation conditions (1atm) for 16 h at room temperature. The reaction mixture was filteredthrough celite and washed with EtOH. The filtrate was concentrated undervacuum and precipitated from MTBE/hexanes to afford compound XI-z (205mg, 87%) as a colorless oil. ¹H NMR (400 MHz, CD₃OD): δ 7.47-7.43 (m,4H), 7.32-7.27 (m, 6H), 6.93-6.89 (m, 2H), 5.52 (s, 2H), 4.27-4.15 (m,4H), 3.99-3.86 (m, 4H), 3.76-3.73 (m, 2H), 3.16-3.09 (m, 3H), 3.02-2.82(m, 6H), 2.78-2.69 (m, 7H), 2.59 (t, J=7.6 Hz, 2H), 1.80-1.71 (m, 5H),1.69-1.53 (m, 5H).

Preparation of Compound XI-bb

A solution of compound XI-z (205 mg, 0.205 mmol) and methyl3,5-diamino-6-chloropyrazine-2-carbonylcarbamimidothioate hydroiodicacid salt (XI-aa, 85 mg, 0.328 mmol) in EtOH (25 mL) was charged withDIPEA (211 mg, 1.64 mmol) at room temperature. The reaction mixture washeated at 70° C. in a sealed tube for 2 h, cooled to room temperature,and concentrated in vacuo. The residue was purified by columnchromatography (silica gel, 10:1 CH₂Cl₂/MeOH, 8:2:0.2 CHCl₃/CH₃OH/NH₄OH)to afford compound XI-bb (160 mg, 63%) as a yellow solid. ¹H NMR (300MHz, CD₃OD): δ 7.46-7.42 (m, 4H), 7.30-7.28 (m, 6H), 6.89 (br s, 2H),5.47 (s, 2H), 4.24-4.19 (m, 2H), 3.99-3.83 (m, 6H), 3.71-3.53 (m, 5H),2.83-2.73 (m, 6H), 2.64-2.52 (m, 8H), 1.77 (br s, 4H), 1.66-1.55 (m,6H).

Preparation of the Hydrochloride Salt of3,5-diamino-N—(N-(4-(4-((S)-3-amino-2-(3-(bis((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-3-oxopropyl)-5,6,7,8-tetrahydronaphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide(Compound XI-cc)

A solution of compound XI-bb (160 mg, 0.134 mmol) in 4 N aqueous HCl(5.0 mL) was stirred at room temperature for 3 h. The solvent wasremoved and the residue was purified by C18 reverse phase Gold column toafford compound XI-cc (75 mg, 56%) as a yellow hygroscopic solid. ¹H NMR(400 MHz, CD₃OD): δ 6.99 (s, 2H), 4.22-4.18 (m, 2H), 3.97-3.91 (m, 1H),3.85-3.64 (m, 11H), 3.50-3.35 (m, 10H), 3.12-3.06 (m, 4H), 2.80-2.75 (m,4H), 2.63 (t, J=7.8 Hz, 2H), 2.20 (br, s, 2H), 1.81-1.64 (m, 8H).

Preparation of Compound XII-a

A suspension of XI-y (510 mg, 0.529 mmol) and 10% Pd/C (150 mg) inEtOH/AcOH (50 mL/10 mL) was subjected to hydrogenation conditions (1atm) for 16 h at room temperature. The reaction mixture was filteredthrough celite and washed with EtOH. The filtrate was concentrated undervacuum and precipitated from MTBE/hexanes to afford compound XII-a (290mg, 85%) as a colorless oil. ¹H NMR (300 MHz, CD₃OD): δ 7.49-7.46 (m,2H), 7.33-7.31 (m, 3H), 6.93 (br s, 2H), 5.57 (s, 1H), 4.29-4.14 (m,2H), 4.03-3.94 (m, 2H), 3.81-3.57 (m, 2H), 3.25-3.15 (m, 6H), 3.09-2.83(m, 7H), 2.72-2.57 (m, 8H), 1.80-1.55 (m, 12H), 1.31-1.25 (m, 16H), 0.89(t, J=6.6 Hz, 3H).

Preparation of Compound XII-c

A solution of compound XII-a (290 mg, 0.349 mmol) and methyl3,5-diamino-6-chloropyrazine-2-carbonylcarbamimidothioate hydroiodicacid salt (XII-b, 145 mg, 0.560 mmol) in EtOH (25 mL) was charged withDIPEA (360 mg, 2.79 mmol) at room temperature. The reaction mixture washeated at 70° C. in a sealed tube for 2 h, cooled to room temperature,and concentrated in vacuo. The residue was purified by columnchromatography (silica gel, 10:1 CH₂Cl₂/MeOH, 8:2:0.2 CHCl₃/CH₃OH/NH₄OH)to afford compound XII-c (250 mg, 65%) as a yellow solid. ¹H NMR (300MHz, CD₃OD): δ 7.45-7.44 (m, 2H), 7.30-7.28 (m, 3H), 6.91 (br s, 2H),5.51 (s, 1H), 5.47 (s, 1H), 4.26-4.21 (m, 1H), 4.00-3.86 (m, 3H),3.76-3.53 (m, 2H), 3.27-3.22 (m, 3H), 2.93-2.67 (m, 7H), 2.62-2.32 (m,9H), 1.78 (br s, 4H), 1.67-1.50 (m, 6H), 1.36-1.11 (m, 8H), 0.86 (t,J=6.6 Hz, 3H).

Preparation of the Hydrochloride Salt of3,5-diamino-N—(N-(4-(4-((S)-3-amino-2-(3-(hexyl((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-3-oxopropyl)-5,6,7,8-tetrahydronaphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide(Compound XII-d)

A solution of compound XII-c (250 mg, 0.267 mmol) in 4 N aqueous HCl(5.0 mL) was stirred at room temperature for 3 h. The solvent wasremoved and the residue was purified by C18 reverse phase Gold column toafford compound XII-d (125 mg, 55%) as a yellow hygroscopic solid. ¹HNMR (400 MHz, CD₃OD): δ 6.98 (s, 2H), 4.18-4.14 (m, 1H), 3.84-3.76 (m,2H), 3.71-3.64 (m, 4H), 3.38-3.35 (m, 4H), 3.23-2.99 (m, 7H), 2.80-2.75(m, 4H), 2.63 (t, J=7.8 Hz, 2H), 2.15-2.09 (m, 2H), 1.81-1.64 (m, 10H),1.38 (br, s, 6H), 0.93 (t, J=7.0 Hz, 3H).

Preparation of 2,6-naphthyl homotyrosine derivatives

Preparation of Compound XIII-c

A solution of compound XIII-a (10.0 g, 42.1) in anhydrous CH₃CN (200 mL)was charged with TEA (17.0 g, 168.7 mmol), 10% (t-Bu)₃P in hexanes (1.70g, 8.42 mmol), but-3-yn-1-ol (XIII-b, 4.42 g, 63.1 mmol), and CuI (400mg, 2.10 mmol) at room temperature. The resulting mixture was degassedwith argon for 3 min and Pd(PPh₃)₄ (4.86 g, 4.21 mmol) was added rapidlyin one portion. After degassing with argon for 5 min, the resultingmixture was refluxed for 4 h. The reaction mixture was concentratedunder vacuum and the residue was purified by column (silica gel, 80:20hexanes/EA) to afford compound XIII-c (7.20 g, 76%) as a yellow solid.¹H NMR and LC-MS data is consistent with product. ¹H NMR (300 MHz,CDCl₃): δ 7.85 (br s, 1H), 7.68-7.63 (m, 2H), 7.44-7.40 (m, 1H),7.16-7.08 (m, 2H), 3.87-3.81 (m, 2H), 3.91 (s, 3H), 2.73 (t, J=6.2 Hz,2H), 1.85 (t, J=6.2 Hz, 2H).

Preparation of Compound XIII-d

A suspension of compound XIII-c (7.20 g, 31.7 mmol) and 10% Pd/C (2.16g) in EtOH (50 mL)/AcOH 10 mL) was subjected to hydrogenation conditions(1 atm) for 16 h at room temperature. The reaction mixture was filteredthrough celite and washed with EtOH. The filtrate was concentrated undervacuum, basified with saturated Na₂CO₃, and extracted with ethylacetate. The organic layer was washed with water and brine, and theorganic phase was concentrated under reduced pressure to afford XIII-d(5.20 g, 71%) as an yellow solid, which was directly used for the nextstep. ¹H NMR and LC-MS data is consistent with product. ¹H NMR (300 MHz,CDCl₃): δ 7.65 (d, J=8.4 Hz, 2H), 7.53 (br s, 1H), 7.30-7.25 (m, 2H),7.12-7.10 (m, 2H), 3.90 (s, 3H), 3.67 (t, J=6.4 Hz, 2H), 2.77 (t, J=7.2Hz, 2H), 1.82-1.70 (m, 2H), 1.68-1.58 (m, 2H).

Preparation of Compound XIII-e

A stirred solution of compound XIII-d (5.20 g, 22.5 mmol) in acetone(100 mL) was charged with freshly prepared Jones reagent (1.3 equiv)dropwise at room temperature. The reaction mixture was stirred foranother 30 min at room temperature and Jones reagent (0.5 equiv) wasadded to complete the reaction. The acetone was decanted from thereaction mixture and the solid chromium salts were washed with excessacetone. The acetone layers were combined, quenched with IPA, andconcentrated under reduced pressure to get crude solid. This solid waspurified by acid/base treatment to afford pure compound XIII-e (4.20 g,76%) as off-white solid. ¹H NMR and LC-MS data is consistent withproduct. ¹H NMR (300 MHz, DMSO-d₆): δ 12.04 (s, 1H), 7.76-7.72 (m, 2H),7.59 (br s, 1H), 7.33-7.26 (m, 2H), 7.14-7.10 (m, 1H), 3.85 (s, 3H),2.71 (t, J=7.4 Hz, 2H), 2.24 (t, J=7.4 Hz, 2H), 1.92-1.82 (m, 2H).

Preparation of Compound XIII-g

A solution of compound XIII-e (4.20 g, 17.1 mmol) in dry THF (50 mL) wascharged with triethylamine (4.30 g, 42.8 mmol) and pivaloyl chloride(2.46 g, 20.5 mmol) followed by lithium chloride (860 mg, 20.5 mmol).Compound XIII-f (3.6 g, 20.5 mmol) was added at −25° C., and thereaction mixture was stirred for 2 hours at room temperature. Aftercompletion of the reaction, the reaction mixture was evaporated and theresidue was triturated with 1N NaOH. The aqueous layer was separated andextracted with dichloromethane (2×500 mL). The combined organic extractswere dried over Na₂SO₄ and concentrated. The residue was purified byMTBE and hexane washings to afford compound XIII-g (5.50 g, 79%) as anoff-white solid. ¹H NMR and LC-MS data is consistent with product. ¹HNMR (400 MHz, CDCl₃): δ 7.77-7.63 (m, 2H), 7.58 (br s, 1H), 7.33-7.23(m, 5H), 7.18-7.16 (m, 2H), 7.13-7.10 (m, 2H), 4.62-4.56 (m, 1H),4.12-4.07 (m, 2H), 3.26-3.22 (m, 1H), 3.08-2.94 (m, 2H), 2.86-2.82 (m,2H), 2.72-2.66 (m, 1H), 2.15-2.07 (m, 2H).

Preparation of Compound XIII-h

A solution of compound XIII-g (11.2 g, 27.79 mmol) in dry THF (300 mL)was charged with KHMDS (7.18 g, 36.1 mmol) portionwise at −78° C. Afterthe resulting mixture was stirred for 30 min, trisyl azide (12.8 g,41.68 mmol) was added and the reaction mixture was stirred for 2-3 min.Acetic acid (10.0 g, 166.7 mmol) was added slowly at the sametemperature, followed by tetramethylammonium acetate (14.7 g, 111.1mmol). The mixture was warmed to 27° C., stirred for 4 h, quenched withsaturated NaHCO₃ (300 mL), concentrated to remove THF, and extractedwith EtOAc (2×500 mL). The combined organic extracts were dried overNa₂SO₄ and concentrated. The residue was purified by columnchromatography (silica gel, 70:30 hexane/EtOAc) to afford compoundXIII-h (8.10 g, 65%) as a colorless oil, which was directly used for thenext step. LC-MS data is consistent with product.

Preparation of Compound XIII-i

A solution of compound XIII-h (8.10 g, 18.2 mmol) in THF/H₂O (100 mL/25mL) was charged with H₂O₂ (3.7 g, 109.2 mmol) followed by LiOH (1.56 g,36.4 mmol) portionwise at 0° C. The reaction mixture was stirred for 1 hat the same temperature, quenched with saturated Na₂SO₃ (200 mL),concentrated under reduced pressure to remove THF, and washed withCH₂Cl₂ (200 mL). The aqueous layer was acidified with 1 N aqueous HCland extracted with CH₂Cl₂ (2×250 mL). The combined organic extracts weredried over Na₂SO₄, concentrated, and washed with MTBE to afford compoundXIII-i (4.10 g, 80%) as an off-white solid, which was directly used forthe next step. LC-MS data is consistent with product.

Preparation of Compound XIII-j

A suspension of compound XIII-i (4.10 g, 14.3 mmol) and 10% Pd/C (410Mg) in AcOH/H₂O (50 mL/15 mL) was subjected to hydrogenation conditions(1 atm) for 3 h at room temperature. The reaction mixture was filteredthrough celite and washed with MeOH. The filtrate was concentrated undervacuum to afford acetic salt XIII-j (3.40 g, 91%) as a white solid,which was directly used for the next step. LC-MS data is consistent withproduct.

Preparation of Compound XIII-k

A solution of compound XIII-j (3.40 g, 13.1 mmol) in acetic acid (30 mL)was charged with hydrobromic acid (30 mL) dropwise at room temperatureand the reaction mixture was refluxed for 4 h. The reaction mixture wascooled to room temperature and concentrated. The residue wasconcentrated under reduced pressure to afford compound XIII-k (2.60 g,81%) as a brown solid. ¹H NMR and LC-MS data is consistent with product.¹H NMR (400 MHz, CD₃OD): δ 7.72-7.59 (m, 3H), 7.45-7.27 (m, 1H),7.19-7.03 (m, 1H), 4.01 (t, J=5.8 Hz, 1H), 2.99-2.81 (m, 2H), 2.38-2.14(m, 2H).

Preparation of Compound XIII-l

A solution of compound XIII-k (13.8 g, 56.3 mmol) in MeOH/H₂O (160mL/100 mL) was charged with NaHCO₃ (4.50 g, 112.6 mmol) and Boc₂O (14.7g, 67.5 mmol) at 0° C. The resulting mixture was warmed to roomtemperature and stirred for 3 h. The reaction mixture was partitionedbetween CH₂Cl₂ (200 mL) and water (200 mL). The aqueous layer wasseparated and extracted with CH₂Cl₂ (2×200 mL). The combined organicextracts were washed with brine, dried over Na₂SO₄, and concentrated togive compound XIII-l (14.0 g, 73%) as a white solid. ¹H NMR and LC-MSdata is consistent with product. ¹H NMR (400 MHz, DMSO-d₆): δ 12.43 (brs, 1H), 9.58 (br s, 1H), 7.66-7.58 (m, 2H), 7.52 (br s, 1H), 7.26-7.21(m, 2H), 7.07-7.02 (m, 2H), 3.88-3.82 (m, 1H), 2.79-2.64 (m, 2H),2.01-1.86 (m, 2H), 1.40 (s, 9H).

Preparation of Compound XIII-m

A solution of acid XIII-l (13.7 g, 39.7 mmol) in THF (150 mL) wascharged with DIPEA (7.68 g, 59.5 mmol) and T₃P (18.9 g, 59.5 mmol) at 0°C. The reaction mixture was stirred at the same temperature for 1 h andNH₃ (7.0 N in methanol, 29.4 mL, 206 mmol) was added dropwise. Thereaction mixture was stirred at 0° C. for 1 h, warmed to roomtemperature, and stirred for 1 h. After concentration, the residue waspartitioned between CH₂Cl₂ (100 mL) and water (100 mL). The aqueouslayer was separated and extracted with CH₂Cl₂ (2×100 mL). The combinedorganic extracts were dried over Na₂SO₄ and concentrated. The residuewas washed with MTBE to afford amide XIII-m (7.20 g, 53%) as a paleyellow solid. ¹H NMR and LC-MS data is consistent with product. ¹H NMR(300 MHz, DMSO-d₆): δ 9.60 (s, 1H), 7.66-7.51 (m, 3H), 7.28-7.16 (m,4H), 7.06-6.94 (m, 4H), 6.15 (br s, 1H), 3.90-3.82 (m, 1H), 2.84-2.58(m, 2H), 1.98-1.80 (m, 2H), 1.40 (s, 9H).

Preparation of Compound XIII-n

A solution of compound XIII-m (7.20 g, 20.9 mmol) in pyridine (70 mL)was charged with triflate (8.90 g, 31.3 mmol) at 0° C., and the reactionmixture was stirred at room temperature for 1 h. After concentration,the reaction mixture was partitioned between CH₂Cl₂ (300 mL) and water(300 mL). The aqueous layer was separated and extracted with CH₂Cl₂(2×300 mL). The combined organic extracts were washed with brine, driedover Na₂SO₄, and concentrated to afford compound XIII-n (6.80 g, 69%) asa brown solid, which was directly used for the next step. LC-MS data isconsistent with product.

Preparation of Compound XIII-p

A solution of compound XIII-n (6.80 g, 14.2) in anhydrous CH₃CN (150 mL)was charged with TEA (5.7 g, 57.1 mmol), 10% (t-Bu)₃P in hexanes (0.57g, 2.84 mmol), benzyl but-3-ynylcarbamate (XIII-o, 4.30 g, 21.5 mmol),and CuI (134 mg, 0.71 mmol) at room temperature. The resulting mixturewas degassed with argon for 3 min and Pd(PPh₃)₄ (1.60 g, 1.42 mmol) wasadded rapidly in one portion. After degassing with argon for 5 min, theresulting mixture was refluxed for 4 h. The reaction mixture wasconcentrated under vacuum and the residue was purified by column (silicagel, 80:20 hexanes/EA) to afford compound XIII-p (4.50 g, 60%) as abrown solid. ¹H NMR and LC-MS data is consistent with product. ¹H NMR(300 MHz, CD₃OD): δ 7.83 (s, 1H), 7.72-7.60 (m, 3H), 7.43-7.24 (m, 7H),5.10 (s, 2H), 4.04 (br s, 1H), 3.37 (t, J=6.8 Hz, 2H), 2.85-2.75 (m,2H), 2.64 (t, J=6.8 Hz, 2H), 2.20-1.90 (m, 2H), 1.45 (s, 9H).

Preparation of Compound XIII-q

A suspension of compound XIII-p (4.50 g, 8.50 mmol) and 10% Pd/C (135mg) in EtOH (500 mL)/AcOH (10 mL) was subjected to hydrogenationconditions (1 atm) for 16 h at room temperature. The reaction mixturewas filtered through celite and washed with EtOH. The filtrate wasconcentrated under vacuum and washed with MTBE/hexanes to afford aceticsalt (4.20 g, crude) as an off-white solid, which was directly used forthe next step. LC-MS data is consistent with product.

Preparation of Compound XIII-q

A stirred solution of crude compound from XIII-q (4.20 g, crude) inMeOH/H₂O (100 mL/500 mL) was charged with saturated Na₂CO₃ and CbzCl(2.68 g, 15.7 mmol) at 0° C. and stirred at the same temperature for 1h. The reaction mixture was stirred for 1 h at room temperature. Thesolvent was removed and the mixture was partitioned between CH₂Cl₂ (500mL) and water (100 mL). The aqueous layer was separated and extractedwith CH₂Cl₂ (2×100 mL). The combined organic extracts were washed withbrine, dried over Na₂SO₄, and concentrated to afford compound XIII-q(2.80 g, 62% over two steps) as a yellow oil, which was directly usedfor the next step. LC-MS data is consistent with product.

Preparation of Compound XIII-r

A solution of compound XIII-q (2.80 g, 5.25 mmol) in dioxane was chargedwith 4 N HCl in dioxane (30 mL) and the reaction mixture was stirred for4 h at room temperature. The solvent was removed under vacuum and theresidue was washed with MTBE to afford compound XIII-r (1.90 g, 82%). ¹HNMR and LC-MS data is consistent with product. ¹H NMR (400 MHz, CD₃OD):δ 7.75-7.69 (m, 2H), 7.64-7.54 (m, 2H), 7.36-7.25 (m, 8H), 5.04 (s, 2H),3.98 (t, J=6.4 Hz, 1H), 3.14 (t, J=6.8 Hz, 2H), 2.87 (t, J=7.8 Hz, 2H),2.77 (t, J=7.4 Hz, 2H), 2.33-2.15 (m, 2H), 1.75-1.68 (m, 2H), 1.58-1.51(m, 2H).

Preparation of Compound XIII-s

A solution of compound XIII-r (1.90 g, 4.38 mmol) and aldehyde 2 (910 g,5.26 mmol) in MeOH (80 mL) was charged with acetic acid (2.6 g, 43.8mmol) and the reaction mixture was stirred at room temperature for 10min. Sodium cyanoborohydride (413 mg, 6.57 mmol) was added and thesolution continued to stir at room temperature for 1 h. Additionalcompound 2 (0.3 equiv), AcOH (0.5 equiv), and NaCNBH₃ (0.5 equiv) wereadded and stirred for 1 h. After concentration, the residue waspartitioned between EtOAc (300 mL) and saturated NaHCO₃ (200 mL). Theaqueous layer was separated and extracted with EtOAc (2×300 mL). Thecombined organic extracts were dried over Na₂SO₄ and concentrated toafford the crude residue XIII-s (2.50 g), which was directly used forthe next step. LC-MS data is consistent with product.

Preparation of Compound XIII-t

A solution of compound XIII-s (2.50 g, crude in MeOH/H₂O (80 mL/30 mL)was charged with saturated Na₂CO₃ at 0° C. and the solution was stirredfor 10 min. Benzyl chloroformate (1.0 g, 6.30 mmol) was added dropwiseand the reaction mixture was stirred for 1 h at 0° C., warmed to roomtemperature, and stirred for 1 h. After concentration, the residue wasdissolved in CH₂Cl₂ (200 mL), then washed with water (300 mL) and brine(300 mL). The organic layer was dried over Na₂SO₄, concentrated, andpurified by column chromatography to afford XIII-t (1.90 g, 62% over twosteps), which was directly used for the next step. LC-MS data isconsistent with product.

Preparation of Compound XIII-u

Compound XIII-t (1.90 g, 2.62 mmol) was dissolved in 4 N HCl in dioxane(30 mL) at room temperature and the solution was stirred for 2 h. Afterconcentration, the residue was washed with MTBE to afford compoundXIII-u (1.30 g, 82%) as an off-white solid. ¹H NMR and LC-MS data isconsistent with product. ¹H NMR (300 MHz, CD₃OD): δ 7.69-7.63 (m, 2H),7.56-7.55 (m, 2H), 7.35-7.21 (m, 16H), 5.15-5.04 (m, 5H), 4.59-4.45 (m,2H), 3.75-3.59 (m, 9H), 3.57-3.34 (m, 3H), 3.20-3.12 (m, 5H), 3.08-2.94(m, 6H), 2.76 (t, J=7.4 Hz, 4H), 2.35-2.15 (m, 3H), 2.02-1.81 (m, 6H),1.76-1.49 (m, 4H).

Preparation of Compound XIII-w and XIII-x

A solution of compound XIII-u (1.30 mg, 2.08 mmol) and triol XIII-v(1.08 g, 4.16 mmol) in methanol (80 mL) was charged with acetic acid(1.2 g, 20.8 mmol) and the reaction mixture was stirred at roomtemperature for 10 min. Sodium cyanoborohydride (193 mg, 3.12 mmol) wasadded and the solution continued to stir at room temperature for 24 h.Additional compound XIII-x (2.0 equiv), AcOH (4.0 equiv), and NaCNBH₃(3.0 equiv) were added and the solution continued to stir at roomtemperature for 24 h. Hexanal (1.0 mL, 10.4 mmol), AcOH (1.10 mL), andNaCNBH₃ (193 mg, 3.12 mmol) were added and the reaction mixture wasstirred for 2 h. After concentration, the residue was partitionedbetween EtOAc (300 mL) and saturated NaHCO₃ (200 mL). The aqueous layerwas separated and extracted with EtOAc (2×300 mL). The combined organicextracts were dried over Na₂SO₄ and concentrated. The residue waspurified by C18 reverse phase Gold column to afford compound XIII-w (550mg, 25%) and compound XIII-x (400 mg, 21%) as white solids. ¹H NMR andLC-MS data is consistent with product.

¹H NMR for compound XIII-w (300 MHz, CD₃OD): δ 7.67-7.65 (m, 2H),7.55-7.40 (m, 3H), 7.31-7.26 (m, 22H), 5.42-5.29 (m, 2H), 5.04 (s, 4H),4.21-4.15 (m, 2H), 3.94-3.84 (m, 6H), 3.68-3.50 (m, 5H), 3.14 (t, J=6.8Hz, 2H), 2.78-2.61 (m, 10H), 1.73-1.68 (m, 4H), 1.58-1.51 (m, 2H).

¹H NMR for compound XIII-x (400 MHz, CD₃OD): δ 7.68 (d, J=7.4 Hz, 2H),7.53-7.49 (m, 2H), 7.42-7.27 (m, 16H), 5.48-5.42 (m, 1H), 5.11 (br s,2H), 5.04 (s, 2H), 4.50-4.38 (m, 1H), 4.23-4.19 (m, 1H), 3.97-3.88 (m,3H), 3.75-3.48 (m, 3H), 3.13-3.10 (m, 3H), 2.78-2.71 (m, 5H), 2.48-2.29(m, 5H), 2.15-2.02 (m, 1H), 1.80-1.51 (m, 6H), 1.33-1.14 (m, 6H), 0.82(t, J=6.8 Hz, 3H).

Preparation of Compound XIII-z

A suspension of XIII-y (550 mg, 0.487 mmol) and 10% Pd/C (165 mg) inEtOH/AcOH (50 mL/10 mL) was subjected to hydrogenation conditions (1atm) for 8 h at room temperature. The reaction mixture was filteredthrough celite and washed with EtOH. The filtrate was concentrated undervacuum and precipitated from MTBE/hexanes to afford compound XIII-z (400mg, 95%) as a colorless oil. ¹H NMR (300 MHz, CD₃OD): δ 7.73-7.56 (m,4H), 7.41-7.23 (m, 14H), 5.45 (s, 2H), 4.25-4.13 (m, 5H), 3.98-3.83 (m,5H), 3.74-3.50 (m, 6H), 3.13-2.98 (m, 5H), 3.00-2.71 (m, 10H), 1.82-1.66(m, 7H).

Preparation of Compound XIII-aa

A solution of compound XIII-z (400 mg, 0.465 mmol) and methyl3,5-diamino-6-chloropyrazine-2-carbonylcarbamimidothioate hydroiodicacid salt (XIII-aa, 193 mg, 0.744 mmol) in EtOH (50 mL) was charged withDIPEA (480 mg, 3.72 mmol) at room temperature. The reaction mixture washeated at 70° C. in a sealed tube for 2 h, cooled to room temperature,and concentrated in vacuo. The residue was purified by columnchromatography (silica gel, 10:1 CH₂Cl₂/MeOH, 8:2:0.2 CHCl₃/CH₃OH/NH₄OH)to afford compound XIII-bb (350 mg, 70%) as a yellow solid. ¹H NMR (300MHz, CD₃OD): δ 7.72-7.67 (m, 2H), 7.60 (d, J=9.6 Hz, 2H), 7.44-7.41 (m,4H), 7.34-7.26 (m, 8H), 5.49 (s, 1H), 5.45 (s, 2H), 4.24-4.18 (m, 2H),3.99-3.90 (m, 4H), 3.85-3.82 (m, 2H), 3.71-3.68 (m, 2H), 3.56 (t, J=10.5Hz, 2H), 3.16-3.06 (m, 1H), 2.85-2.74 (m, 4H), 2.68-2.62 (m, 4H),2.58-2.47 (m, 3H), 1.98-1.81 (m, 6H), 1.70-1.58 (m, 4H).

Preparation of the Hydrochloride Salt of3,5-diamino-N—(N-(4-(6-((S)-4-amino-3-(3-(bis((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)naphthalen-2-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide(XIII-bb)

A solution of compound XIII-aa (350 mg, 0.326 mmol) in 1 N aqueous HCl(5.0 mL) was stirred at room temperature for 3 h. The solvent wasremoved and the residue was purified by C18 reverse phase Gold column toafford compound XIII-bb (250 mg, 86%) as a yellow hygroscopic solid. ¹HNMR (400 MHz, CD₃OD): δ 7.75 (d, J=7.8 Hz, 2H), 7.60 (br, s, 2H),7.37-7.32 (m, 2H), 4.16 (br, s, 2H), 3.81-3.75 (m, 4H), 3.73-3.63 (m,6H), 3.48-3.44 (m, 2H), 3.37-3.34 (m, 7H), 3.13-3.10 (m, H), 2.85 (t,J=2 Hz, 4H), 2.25-2.15 (m, 3H), 1.92-1.69 (m, 4H).

Preparation of XIV-a

A suspension of XIII-x (400 mg, 0.416 mmol) and 10% Pd/C (120 mg) inEtOH/AcOH (50 mL/10 mL) was subjected to hydrogenation conditions (1atm) for 16 h at room temperature. The reaction mixture was filteredthrough celite and washed with MeOH.

The filtrate was concentrated under vacuum to afford compound XIV-a (270mg, 93%) as a colorless oil. ¹H NMR (400 MHz, CD₃OD): δ 7.73 (d, J=8.2Hz, 2H), 7.62 (d, J=6.2 Hz, 2H), 7.48-7.39 (m, 3H), 7.36-7.24 (m, 6H),5.52 (s, 1H), 4.23-4.15 (m, 2H), 4.00-3.94 (m, 2H), 3.80-3.77 (m, 1H),3.64-3.57 (m, 2H), 3.22-3.07 (m, 4H), 3.04-2.91 (m, 3H), 2.85-2.75 (m,6H), 1.82-1.77 (m, 4H), 1.73-1.54 (m, 5H), 1.33-1.11 (m, 10H), 0.82 (t,J=6.8 Hz, 3H).

Preparation of XIV-c

A solution of compound XIV-a (270 mg, 0.390 mmol) and methyl3,5-diamino-6-chloropyrazine-2-carbonylcarbamimidothioate hydroiodicacid salt (XIV-b, 163 mg, 0.62 mmol) in EtOH (50 mL) was charged withDIPEA (402 mg, 3.12 mmol) at room temperature. The reaction mixture washeated at 70° C. in a sealed tube for 2 h, cooled to room temperature,and concentrated in vacuo. The residue was purified by columnchromatography (silica gel, 10:1 CH₂Cl₂/MeOH, 8:2:0.2 CHCl₃/CH₃OH/NH₄OH)to afford compound XIV-c (180 mg, 57%) as a yellow solid. ¹H NMR (400MHz, CD₃OD): δ 7.71-7.68 (m, 2H), 7.60-7.59 (m, 2H), 7.46-7.42 (m, 2H),7.34-7.25 (m, 5H), 5.50 (s, 1H), 4.25-4.21 (m, 1H), 4.01-3.88 (m, 3H),3.76-3.71 (m, 1H), 3.63-3.55 (m, 1H), 3.15-3.09 (m, 1H), 2.84-2.73 (m,5H), 2.61-2.43 (m, 8H), 2.02-1.79 (m, 4H), 1.73-1.59 (m, 4H), 1.43-1.41(m, 2H), 1.29-1.15 (m, 8H), 2.02-1.79 (m, 4H), 1.73-1.59 (m, 4H),1.43-1.41 (m, 2H), 1.29-1.15 (m, 8H), 0.84 (t, J=6.8 Hz, 3H).

Preparation of the Hydrochloride Salt of3,5-diamino-N—(N-(4-(6-((S)-4-amino-3-(3-(hexyl((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)naphthalen-2-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide(XIV-d)

A solution of compound XIV-c (180 mg, 0.199 mmol) in 4 N aqueous HCl(2.0 mL) was stirred at room temperature for 2 h. The solvent wasremoved and the residue was purified by C18 reverse phase Gold column toafford compound XIV-d (82 mg, 50%) as a yellow hygroscopic solid. ¹H NMR(400 MHz, CD₃OD): δ 7.75 (d, J=8.4 Hz, 2H), 7.66 (d, J=8.4 Hz, 2H), 7.38(t, J=7.8 Hz, 2H), 4.18-4.16 (m, 1H), 4.04-4.02 (m, 1H), 3.85-3.76 (m,2H), 3.71-3.64 (m, 3H), 3.48-3.46 (m, 1H), 3.38-3.34 (m, 8H), 3.25-3.08(m, 5H), 2.92-2.81 (m, 4H), 1.38 (br s, 6H), 0.93 (t, J=6.6 Hz, 3H).

Preparation of Compound XV-b

A solution of compound XV-a (100 g, 674 mmol) in dry THF (600 mL) wascharged with dimethyl sulfate (102 g, 809 mmol) followed by NaOH (32.4g, 809 mmol) at 0° C. The resulting reaction mixture was stirred at roomtemperature for 3 hours. After completion of the reaction, the reactionmixture was concentrated to remove the solvent and diluted with water.The aqueous layer was extracted with ethyl acetate (2×500 mL). Thecombined organic extracts were dried over Na₂SO₄ and concentrated. Theresidue was purified by column chromatography (silica gel, 90:10hexane/EtOAc) to afford compound XV-b (108 g, 98%) as a colorless oil.¹H NMR (400 MHz, CDCl₃): δ7.05 (t, J=7.8 Hz, 1H), 6.69 (d, J=7.6 Hz,1H), 6.64 (d, J=7.9 Hz, 1H), 3.80 (s, 3H), 2.74 (t, J=6.2 Hz, 2H), 2.64(t, J=6.2 Hz, 2H), 1.81-1.71 (m, 4H).

Preparation of Compound XV-c

A solution of succinic anhydride (12.3 g, 123 mmol) in CH₂Cl₂ (150 mL)was charged with AlCl₃ (18.4 g, 138 mmol) portionwise at 0° C. After 10minutes, compound XV-b (20.0 g, 123 mmol) dissolved in CH₂Cl₂ (50 mL)was added to the reaction mixture at the same temperature. The reactionmixture was stirred at room temperature for 3 hours. After completion ofthe reaction, the reaction mixture was poured into ice-cold water andacidified with HCl. The reaction mixture was filtered through a Celitepad to remove Al(OH)₃ and washed with hot ethyl acetate. The aqueouslayer was extracted with ethyl acetate. The solvent was concentrated toget a solid, and the compound was further purified by triturating withhexane washing to get compound XV-c (22.3 g, 69%) as a white solid. ¹HNMR and LC-MS data is consistent with product. ¹H NMR (400 MHz, CD₃OD):δ □7.68 (d, J=8.7 Hz, 1H), 6.80 (d, J=8.7 Hz, 1H), 3.86 (s, 3H), 3.16(t, J=6.4 Hz, 2H), 2.90 (t, J=6.4 Hz, 2H), 2.67-2.60 (m, 4H), 1.78-1.64(m, 4H).

Preparation of Compound XV-d

A solution of compound XV-c (30 g, 114 mmol) in toluene (300 mL) wascharged with concentrated hydrochloric acid (300 mL) followed by Zn dust(74.8 g, 1145 mmol) portionwise at room temperature. The reactionmixture was heated to reflux for 3 h, cooled down to room temperature,and filtered through Celite. After the filtrate was concentrated to 50%,the resulting precipitate was filtered and dried to afford compound XV-d(24.0 g, 85%) as an off-white solid. ¹H NMR and LC-MS data is consistentwith product. ¹H NMR (400 MHz, CD₃OD): δ □6.90 (d, J=8.4 Hz, 1H), 6.63(d, J=8.4 Hz, 1H), 3.75 (s, 3H), 2.67 (t, J=5.9 Hz, 2H), 2.61 (t, J=5.9Hz, 2H), 2.57-2.49 (m, 2H), 2.35-2.28 (m, 2H), 1.85-1.68 (m, 4H).

Preparation of Compound XV-e

A solution of compound XV-d (20 g, 80.6 mmol) in dry THF (500 mL) wascharged with Et₃N (28 mL, 96.8 mmol), PivCl (11.9 mL, 96.7 mmol), andLiCl (3.418 g, 96.8 mmol), followed by compound XV-f (17.1 g, 96.8 mmol)at −25° C., and the reaction mixture was stirred for 2 hours at roomtemperature. After completion of the reaction, the reaction mixture wasevaporated and the residue was treated with 1 N NaOH. The aqueous layerwas separated and extracted with dichloromethane (2×500 mL). Thecombined organic extracts were dried over Na₂SO₄ and concentrated. Theresidue was purified by triturating with MTBE and hexane to get compoundXV-e (26 g, 79%) as a solid. ¹H NMR (400 MHz, CDCl₃): δ □7.37-7.27 (m,3H), 7.23-7.15 (m, 2H), 6.98 (d, J=8.5 Hz, 1H), 6.63 (d, J=8.5 Hz, 1H),4.70-4.61 (m, 1H), 4.21-4.11 (m, 2H), 3.78 (s, 3H), 3.30 (dd, J=9.7 Hz,1H), 3.14-2.79 (m, 3H), 2.80-2.52 (m, 7H), 2.05-1.88 (m, 2H), 1.89-1.64(m, 4H).

Preparation of Compound XV-g

A solution of compound XV-e (30.0 g, 73.7 mmol) in dry THF (300 mL) wascharged with KHMDS (19.1 g, 95.8 mmol) portionwise at −78° C. After theresulting mixture was stirred for 30 min, trisyl azide (34.2 g, 110.6mmol) was added and the reaction mixture was stirred for 2-3 min. Aceticacid (26.5 g, 442 mmol) was added slowly at the same temperaturefollowed by tetramethylammonium acetate (29.5 g, 221 mmol). The reactionmixture was warmed to 27° C., stirred for 4 h, quenched with saturatedNaHCO₃ (300 mL), concentrated to remove THF, and extracted with EtOAc(2×500 mL). The combined organic extracts were dried over Na₂SO₄ andconcentrated. The residue was purified by column chromatography (silicagel, 70:30 hexane/EtOAc) to afford compound XV-g (18.3 g, 55%) as acolorless oil. ¹H NMR (400 MHz, CDCl₃): δ 7.37-7.27 (m, 3H), 7.23-7.18(m, 2H), 6.96 (d, J=8.4 Hz, 1H), 6.62 (d, J=8.4 Hz, 1H), 5.03-4.98 (m,1H), 4.61-4.54 (m, 2H), 4.23-4.10 (m, 2H), 3.77 (s, 3H), 3.32 (dd,J=10.3 Hz, 1H), 2.86-2.77 (m, 2H), 2.73-2.61 (m, 5H), 2.17-2.07 (m, 1H),2.05-1.95 (m, 1H), 1.82-1.70 (m, 4H).

Preparation of Compound XV-h

A solution of compound XV-g (40.5 g, 20.0 mmol) in THF/H₂O (150 mL/50mL) was charged with H₂O₂ (61.4 mL, 542 mmol) followed by LiOH (7.57 g,181 mmol) portionwise at 0° C. The reaction mixture was stirred for 1 hat the same temperature, quenched with saturated aqueous Na₂SO₃ (200mL), concentrated under reduced pressure to remove THF, and washed withCH₂Cl₂ (200 mL). The aqueous layer was acidified with 1 N aqueous HCland extracted with CH₂Cl₂ (2×250 mL). The combined organic extracts weredried over Na₂SO₄, concentrated, and triturated with MTBE to affordcompound XV-h (20.0 g, 77%) as an off-white solid. ¹H NMR (300 MHz,CD₃OD): δ □6.91 (d, J=8.4 Hz, 1H), 6.64 (d, J=8.4 Hz, 1H), 3.93 (dd,J=7.9, 4.1 Hz, 1H), 3.74 (s, 3H), 2.72-2.55 (m, 6H), 2.08-1.83 (m, 2H),1.81-1.63 (m, 4H).

Preparation of Compound XV-i

A suspension of compound XV-h (41.0 g, 144 mmol) and 10% Pd/C (8.0 g) inAcOH/H₂O (480 mL/160 mL) was subjected to hydrogenation conditions (1atm) for 16 h at room temperature. The reaction mixture was filteredthrough Celite and washed with MeOH. The filtrate was concentrated undervacuum to afford acetic salt XV-i (40.0 g, 86%) as a yellow solid. ¹HNMR (400 MHz, DMSO-d₆): δ 6.98 (d, J=8.8 Hz, 1H), 6.69 (d, J=8.8 Hz,1H), 3.97 (t, J=6.3 Hz, 1H), 3.76 (s, 3H), 2.76-2.55 (m, 7H), 2.14-1.99(m, 2H), 1.84-1.67 (m, 5H), 1.93 (s, 3H).

Preparation of Compound XV-j

A solution of compound XV-i (41.3 g, 128 mmol) in acetic acid (250 mL)was charged with hydrobromic acid (250 mL) dropwise at room temperatureand the reaction mixture was refluxed for 16 h. The reaction mixture wascooled to room temperature and concentrated. The residue was dilutedwith H₂O (15 mL), slightly basified with ammonia, and crystallizedovernight to afford compound XV-j (40.0 g, 95%) as a brown solid. ¹H NMR(400 MHz, DMSO-d₆): δ □8.35 (brs, 1H), 6.74 (d, J=7.7 Hz, 1H), 6.56 (d,J=7.7 Hz, 1H), 4.01-3.90 (m, 1H), 2.55-2.38 (m, 4H), 2.05-1.85 (m, 2H),1.78-1.56 (m, 6H),

Preparation of Compound XV-k

Acetyl chloride (60.5 mL, 852 mmol) was added to dry methanol (400 mL)at 0° C., followed by compound XV-j (40.0 g, 122 mmol). The reactionmixture was refluxed for 3 h and concentrated. The residue waspartitioned between CH₂Cl₂ (500 mL) and saturated NaHCO₃ (300 mL). Theaqueous layer was separated and extracted with CH₂Cl₂ (2×300 mL). Thecombined organic extracts were dried over Na₂SO₄ and concentrated toafford compound XV-k (30.0 g, 83%) as a colorless oil. ¹H NMR (400 MHz,CD₃OD): δ 6.77 (d, J=8.2 Hz, 1H), 6.50 (d, J=8.2 Hz, 1H), 3.72 (s, 3H),3.51 (t, J=6.2 Hz, 1H), 2.70-2.57 (m, 4H), 2.53 (t, J=8.5 Hz, 2H),1.83-1.69 (m, 6H).

Preparation of Compound XV-l

A solution of compound XV-k (30.0 g, 114 mmol) in MeOH/H₂O (300 mL/100mL) was charged with NaHCO₃ (39.0 g, 456 mmol) and Boc₂O (30.0 g, 137mmol) at 0° C. The resulting mixture was warmed to room temperature andstirred for 3 h. The reaction mixture was partitioned between CH₂Cl₂(200 mL) and water (200 mL). The aqueous layer was separated andextracted with CH₂Cl₂ (2×200 mL). The combined organic extracts werewashed with brine and dried over Na₂SO₄, and the residue was purified bycolumn chromatography (silica gel, 70:30 hexanes/EA) to afford compoundXV-l (31.0 g, 85%) as a colorless oil. ¹H NMR (400 MHz, CDCl₃): δ □6.80(d, J=8.0 Hz, 1H), 6.56 (d, J=8.0 Hz, 1H), 5.32 (brs, 1H), 5.29 (s, 1H),4.45-4.30 (m, 1H), 3.73 (s, 3H), 2.69-2.43 (m, 6H), 1.88-1.72 (m, 6H),1.46 (s, 9H).

Preparation of Compound XV-m

A solution of compound XV-l (31.0 g, 85.4 mmol) in pyridine (70 mL) wascharged with triflate (21.5 mL, 128 mmol) at 0° C., and the reactionmixture was stirred at room temperature for 1 h. After concentration,the reaction mixture was partitioned between CH₂Cl₂ (300 mL) and water(300 mL). The aqueous layer was separated and extracted with CH₂Cl₂(2×300 mL). The combined organic extracts were washed with brine, driedover Na₂SO₄, and concentrated to afford compound XV-m (41.0 g crude) asa brown oil. ¹H NMR (400 MHz, CDCl₃): δ □7.01 (s, 2H), 5.22-5.11 (m,1H), 4.44-4.34 (m, 1H), 3.74 (s, 3H), 2.78 (t, J=6.0 Hz, 2H), 2.71-2.52(m, 4H), 2.16-2.02 (m, 1H), 1.89-1.73 (m, 5H), 1.45 (s, 9H).

Preparation of Compound XV-o

A solution of compound XV-m (41.0 g, crude) in anhydrous CH₃CN (400 mL)was charged with TEA (46.8 mL, 342 mmol), 10% (t-Bu)₃P in hexanes (34.5mL, 17.0 mmol), benzyl but-3-ynylcarbamate (XV-n, 20.6 g, 103 mmol), andCuI (0.81 g, 4.26 mmol) at room temperature. The resulting mixture wasdegassed with argon for 3 min and Pd(PPh₃)₄ (9.86 g, 8.53 mmol) wasadded rapidly in one portion. After degassing with argon for 5 min, theresulting mixture was refluxed for 16 h. The reaction mixture wasconcentrated under vacuum and the residue was purified by column (silicagel, 80:20 hexanes/EA) to afford compound XV-o (25 g, 54% over twosteps) as a brown oil. ¹H NMR (400 MHz, CDCl₃): δ 7.38-7.31 (m, 5H),7.15 (d, J=7.9 Hz, 1H), 6.88 (d, J=7.9 Hz, 1H), 5.19-5.05 (m, 4H),4.43-4.31 (m, 1H), 3.73 (s, 3H), 3.47-3.37 (m, 2H), 2.82 (t, J=6.7 Hz,2H), 2.69-2.55 (m, 5H), 2.13-2.00 (m, 1H), 1.82-1.70 (m, 6H), 1.45 (s,9H).

Preparation of Compound XV-p

A solution of methyl ester XV-o (23.0 g, 42.0 mmol) in THF/MeOH/H₂O (200mL/200 mL/65 mL) was charged with NaOH (10.0 g, 252 mmol) and thereaction mixture was stirred at room temperature for 1 h. The pH valuewas adjusted to 9 with 1 N aqueous HCl and the organic solvent wasremoved. The pH value of the residue was adjusted to 5, and thesuspension was partitioned between CH₂Cl₂ (200 mL) and water (200 mL).The aqueous layer was separated and extracted with CH₂Cl₂ (2×200 mL).The combined organic extracts were dried over Na₂SO₄ and concentrated toafford compound XV-p (16.0 g, 72%) as a brown solid. ¹H NMR (400 MHz,CD₃OD): δ 7.38-7.20 (m, 5H), 7.09 (d, J=8.6 Hz, 1H), 6.89 (d, J=8.5 Hz,1H), 5.08 (s, 2H), 4.16-4.02 (m, 1H), 3.34 (t, J=7.3 Hz, 2H), 2.81 (t,J=6.4 Hz, 2H), 2.70-2.58 (m, 6H), 2.08-1.93 (m, 1H), 1.90-1.81 (m, 1H),1.80-1.68 (m, 4H), 1.45 (s, 9H).

Preparation of Compound XV-q

A solution of acid XV-p (11.0 g, 20.6 mmol) in THF (200 mL) was chargedwith NMM (3.39 mL, 31.0 mmol) and PivCl (3.0 mL, 24.7 mmol) at 0° C. Thereaction mixture was stirred at the same temperature for 1 h and NH₃(7.0 N in methanol, 29.4 mL, 206 mmol) was added dropwise. The reactionmixture continued to stir at 0° C. for 1 h, was warmed to roomtemperature, and stirred for 1 h. After concentration, the residue waspartitioned between CH₂Cl₂ (100 mL) and water (100 mL). The aqueouslayer was separated and extracted with CH₂Cl₂ (2×100 mL). The combinedorganic extracts were dried over Na₂SO₄ and concentrated. The residuewas triturated with MTBE to afford amide XV-q (12.0 g, crude) as ayellow solid. ¹H NMR (400 MHz, CD₃OD): δ 7.35-7.22 (m, 5H), 7.09 (d,J=8.3 Hz, 1H), 6.88 (d, J=8.3 Hz, 1H), 5.07 (s, 2H), 4.09-3.97 (m, 1H),3.39 (t, J=6.9 Hz, 2H), 2.80 (t, J=6.5 Hz, 2H), 2.70-2.56 (m, 6H),1.82-1.67 (m, 6H), 1.45 (s, 9H).

Preparation of Compound XV-r

A suspension of compound XV-q (12.0 g, crude) and 10% Pd/C (2.50 g) inEtOH (300 mL)/AcOH 960 mL) was subjected to hydrogenation conditions (1atm) for 16 h at room temperature. The reaction mixture was filteredthrough Celite and washed with EtOH. The filtrate was concentrated undervacuum and triturated with MTBE/hexanes to afford acetic salt XV-r (12.0g, crude) as an off-white solid. This product was directly used for thenext step. [M+H]⁺ 264.

Preparation of Compound XV-s

A stirred solution of compound XV-r (12.0 g, crude) in MeOH (300mL)/water (100 mL) was charged with Na₂CO₃ (21.8 g, 206 mmol) and CbzCl(6.27 mL, 41.2 mmol) at 0° C. and stirred at the same temperature for 1h. The reaction mixture was stirred for 1 h at room temperature, and thesolvent was removed and partitioned between CH₂Cl₂ (500 mL) and water(100 mL). The aqueous layer was separated and extracted with CH₂Cl₂(2×100 mL). The combined organic extracts were washed with brine, driedover Na₂SO₄, and concentrated to afford compound XV-s (15.0 g, crude) asyellow oil. This product was directly used for the next step. [M+H]⁺538.

Preparation of Compound XV-t

A solution of compound XV-s (15.0 g, crude) was charged with 4 N HCl indioxane (60 mL) and the reaction mixture was stirred for 1 h at roomtemperature. The solvent was removed under vacuum and the residue wastriturated with MTBE to afford compound XV-t (15.0 g, crude). Thisproduct was directly used for the next step. [M+H]⁺ 438.

Preparation of Compound XV-u

A solution of compound XV-t (15.0 g, crude) and aldehyde 2 (4.27 g, 24.2mmol) in MeOH (100 mL) was charged with acetic acid (12.5 mL) and thereaction mixture was stirred at room temperature for 10 min. Sodiumcyanoborohydride (1.94 g, 30.9 mmol) was added and the solutioncontinued to stir at room temperature for 1 h. Additional compound XV-u(0.3 equiv), AcOH (0.5 equiv), and NaCNBH₃ (0.5 equiv) were added andstirred for 1 h. After concentration, the residue was partitionedbetween EtOAc (300 mL) and saturated NaHCO₃ (200 mL). The aqueous layerwas separated and extracted with EtOAc (2×300 mL). The combined organicextracts were dried over Na₂SO₄ and concentrated. The residue (20 g,crude) was directly used for the next step without further purification.[M+H]⁺ 595.

Preparation of Compound XV-w

A solution of compound XV-u (20 g, crude in MeOH/H₂O (300 mL/100 mL) wascharged with Na₂CO₃ (21.8 g, 206 mmol) at 0° C. and the solution wasstirred for 10 min. Benzyl chloroformate (6.77 mL, 41.2 mmol) was addeddropwise and the reaction mixture was stirred for 1 h at 0° C., warmedto room temperature, and stirred for 1 h. After concentration, theresidue was dissolved in CH₂Cl₂ (200 mL) and washed with water (300 mL)and brine (300 mL). The organic layer was dried over Na₂SO₄ andconcentrated. The residue (20 g, crude) was directly used for the nextstep without further purification. [M+Na]⁺ 752.

Preparation of Compound XV-w

Compound XV-v (20 g, crude) was dissolved in 4 N HCl in dioxane (50 mL)at room temperature and the solution was stirred for 2 h. Afterconcentration, the residue was triturated with MTBE, neutralized withaqueous NaHCO₃, and purified by flash-column chromatography using CMAsystem to afford compound XV-w (3.50 g, 27% over 7 steps) as anoff-white solid. ¹H NMR (400 MHz, CD₃OD): δ 7.43-7.24 (m, 10H), 6.83 (s,2H), 5.16 (s, 2H), 5.05 (s, 2H), 4.54-4.42 (m, 1H), 3.58-3.44 (m, 1H),3.42-3.33 (m, 2H), 3.15-3.10 (m, 2H), 3.00-2.86 (m, 2H), 2.71-2.57 (m,4H), 2.56-2.45 (m, 5H), 2.32-1.87 (m, 2H), 1.79-1.65 (m, 4H), 1.59-1.48(m, 4H).

Preparation of Compound XV-y and XV-z

A solution of compound XV-w (3.50 mg, 5.57 mmol) and triol XV-x (6.00 g,22.3 mmol) in methanol (50 mL) was charged with acetic acid (3.35 mL)and the reaction mixture was stirred at room temperature for 10 min.Sodium cyanoborohydride (1.40 g, 22.3 mmol) was added and the solutioncontinued to stir at room temperature for 24 h. Additional compound XV-x(2.0 equiv), AcOH (4.0 equiv), and NaCNBH₃ (3.0 equiv) were added andthe solution continued to stir at room temperature for 24 h. Hexanal(2.00 mL, 16.8 mmol), AcOH (1.10 mL), and NaCNBH₃ (1.75 g, 27.9 mmol)were added and the reaction mixture was stirred for 2 h. Afterconcentration, the residue was partitioned between EtOAc (300 mL) andsaturated NaHCO₃ (200 mL). The aqueous layer was separated and extractedwith EtOAc (2×300 mL). The combined organic extracts were dried overNa₂SO₄ and concentrated. The residue was purified by C18 reverse phaseGold column to afford compound XV-z (2.50 g, 40%) and compound XV-y(1.30 g, 24%) as white solids: ¹H NMR (400 MHz, CD₃OD): δ □7.51-7.19 (m,20H), 6.87-6.74 (m, 2H), 5.51-5.32 (m, 2H), 5.16-5.20 (m, 2H), 4.45-4.25(m, 1H), 4.20 (dd, J=10.8, 5.6 Hz, 2H), 4.00-3.90 (m, 3H), 3.89-3.80 (m,2H), 3.75-3.63 (m, 2H), 3.55 (t, J=11.3 Hz, 2H), 3.11 (t, J=6.5 Hz, 2H),2.80-2.36 (m, 12H), 2.20-2.01 (m, 1H), 1.99-1.83 (m, 1H), 1.82-1.62 (m,6H), 1.57-1.44 (m, 4H), 1.41-1.21 (m, 2H), 0.94-0.86 (m, 1H).

Preparation of Compound XV-aa

A suspension of XV-z (2.50 g, 2.20 mmol) and 10% Pd/C (500 mg) inEtOH/AcOH (100 mL/20 mL) was subjected to hydrogenation conditions (1atm) for 16 h at room temperature. The reaction mixture was filteredthrough celite and washed with MeOH. The filtrate was concentrated undervacuum and triturated with MTBE/hexanes to afford compound XV-aa (2.20g, 96%) as a white solid. ¹H NMR (400 MHz, CD₃OD): δ 7.45-7.38 (m, 4H),7.30-7.24 (m, 6H), 6.87 (s, 2H), 5.47 (s, 2H), 4.23 (dd, J=10.9, 5.7 Hz,2H), 4.17-4.10 (m, 2H), 3.98-3.90 (m, 2H), 3.84 (dd, J=5.1, 2.3 Hz, 2H),3.72 (dd, J=9.4, 2.3 Hz, 2H), 3.65-3.54 (m, 4H), 3.13-2.96 (m, 4H),2.93-2.81 (m, 2H), 2.80-2.47 (m, 11H), 0.95 (s, 9H), 1.81-1.54 (m, 10H),1.40-1.23 (m, 2H).

Preparation of XV-cc

A solution of compound XV-aa (2.20 g, 2.10 mmol) and methyl3,5-diamino-6-chloropyrazine-2-carbonylcarbamimidothioate hydroiodicacid salt (XV-bb, 1.30 g, 3.36 mmol) in EtOH (15 mL) was charged withDIPEA (2.98 mL, 16.8 mmol) at room temperature. The reaction mixture washeated at 70° C. in a sealed tube for 2 h, cooled to room temperature,and concentrated in vacuo. The residue was purified by columnchromatography (silica gel, 10:1 CH₂Cl₂/MeOH, 8:2:0.2 CHCl₃/CH₃OH/NH₄OH)to afford compound XV-cc (1.24 g, 55%) as a yellow solid. ¹H NMR (400MHz, CD₃OD): δ 7.45-7.39 (m, 4H), 7.35-7.24 (m, 6H), 6.88 (s, 2H), 5.47(s, 2H), 4.21 (dd, J=10.7, 5.3 Hz, 2H), 4.00-3.89 (m, 4H), 3.85 (dd,J=5.1, 2.5 Hz, 2H), 3.70 (dd, J=9.3, 2.5 Hz, 2H), 3.57 (t, J=10.7 Hz,2H), 3.24 (t, J=6.8 Hz, 2H), 3.08 (t, J=6.4 Hz, 1H), 2.74-2.41 (m, 16H),1.80-1.70 (m, 6H), 1.71-1.52 (m, 6H).

Preparation of the Hydrochloride Salt of3,5-diamino-N—(N-(4-(4-((S)-4-amino-3-(3-(bis((2S,3R,4R,5R)-2,3,4,5,6-pentahydroxyhexyl)amino)propylamino)-4-oxobutyl)-5,6,7,8-tetrahydronaphthalen-1-yl)butyl)carbamimidoyl)-6-chloropyrazine-2-carboxamide(XV-dd)

Compound XV-cc (1.24 g, 1.15 mmol) was charged with 4 N aqueous HCl (50mL) and the mixture was stirred at room temperature for 2 h. The solventwas removed and the residue was purified by C18 reverse phase Goldcolumn to afford compound XV-dd (700 mg, 61%) as a yellow hygroscopicsolid. ¹H NMR (400 MHz, DMSO-d₆): δ 10.50 (brs, 1H), 9.67-9.54 (m, 1H),9.25 (t, J=5.4 Hz, 1H), 9.14-9.02 (m, 1H), 8.94-8.87 (m, 2H), 8.86-8.72(m, 1H), 8.23 (brs, 1H), 7.81 (brs, 2H), 7.42 (s, 3H), 6.91 (ABq, J=7.8Hz, 2H), 5.54-5.38 (m, 1), 5.02-4.22 (m, 3H), 4.11-4.00 (m, 2H),3.95-3.84 (m, 1H), 3.71 (d, J=5.0 Hz, 2H), 3.59 (dd, J=10.7, 2.4 Hz,2H), 3.54-3.44 (m, 5H), 3.44 (dd, J=10.9, 5.4 Hz, 2H), 3.42-3.16 (m,13H), 3.03-2.82 (m, 2H), 2.70-2.58 (m, 3H), 2.54 (d, J=9.4 Hz, 1H),2.23-2.10 (m, 2H), 2.09-2.06 (m, 1H), 2.00-1.90 (m, 1H), 1.76-1.67 (m,4H), 1.65-1.48 (m, 5H),

¹H NMR (400 MHz, CD₃OD): δ 6.94 (s, 2H), 4.25-4.18 (m, 2H), 4.03 (t,J=6.2 Hz, 1H), 3.86 (d, J=4.6 Hz, 2H), 3.78 (dd, J=10.6, 2.3 Hz, 2H),3.75-3.62 (m, 6H), 3.61-3.51 (m, 2H), 3.50-3.41 (m, 4H), 3.36 (t, J=7.3Hz, 2H), 3.21-3.09 (m, 2H), 2.77-2.68 (m, 4H), 2.68-2.60 (m, 4H),2.33-2.21 (m, 2H), 2.16-2.05 (m, 2H), 1.83-1.76 (m, 4H), 1.75-1.71 (m,2H), 1.70-1.61 (m, 2H).

HRMS [M+H]⁺ calculated C₃₉H₆₆ClN₁₀O₁₂: 901.4506. and found 901.4553.

Several assays may be used to characterize the compounds of the presentinvention. Representative assays are discussed below.

Assay 1. In Vitro Measure of Sodium Channel Blocking Activity andReversibility

One assay used to assess mechanism of action and/or potency of thecompounds of the present invention involves the determination of lumenaldrug inhibition of airway epithelial sodium currents measured undershort circuit current (I_(SC)) using airway epithelial monolayersmounted in Ussing chambers. This assay is described in detail in Hirsh,A. J., Zhang, J., Zamurs, A., et al. Pharmacological properties ofN-(3,5-diamino-6-chloropyrazine-2-carbonyl)-N′-4-[4-(2,3-dihydroxypropoxy)phenyl]butyl-guanidinemethanesulfonate (552-02), a novel epithelial sodium channel blockerwith potential clinical efficacy for CF lung disease. J. Pharmacol. Exp.Ther. 2008; 325(1): 77-88. Cells obtained from freshly excised human,dog, sheep or rodent airways are seeded onto porous 0.4 micron Snapwell™Inserts (CoStar), cultured at air-liquid interface (ALI) conditions inhormonally defined media, and assayed for sodium transport activity(I_(SC)) while bathed in Krebs Bicarbonate Ringer (KBR) in Usingchambers. All test drug additions are to the lumenal bath with half-logdose addition protocols (from 1×10⁻¹¹ M to 3×10⁻⁵ M), and the cumulativechange in I_(SC) (inhibition) recorded. All drugs are prepared indimethyl sulfoxide as stock solutions at a concentration of 1×10⁻² M andstored at −20° C. Eight preparations are typically run in parallel; twopreparations per run incorporate amiloride and/or benzamil as positivecontrols. After the maximal concentration (5×10⁻⁵ M) is administered,the lumenal bath is exchanged three times with fresh drug-free KBRsolution, and the resultant I_(SC) measured after each wash forapproximately 5 minutes in duration. Reversibility is defined as thepercent return to the baseline value for sodium current after the thirdwash. All data from the voltage clamps are collected via a computerinterface and analyzed off-line.

Dose-effect relationships for all compounds are considered and analyzedby the Prism 3.0 program. IC₅₀ values, maximal effective concentrations,and reversibility are calculated and compared to amiloride and benzamilas positive controls. The potency of the sodium channel blockingactivity of representative compounds relative to amiloride in freshlyexcised cell from canine airways is shown in Table 1.

TABLE 1 Inhibition of Short-Circuit Current by Compound (Ia) in caninebronchial epithelial (CBE) cells (IC₅₀ nM) Potency of Sodium CompoundChannel Blockade Number IC₅₀ (nM) Amiloride 781 II-d 10.6 III-d 2.6 Vd24 VI-d 14.3 XIII-bb 12.5 XIV-d 6.0 XV-dd 7.3 XVI-ee 35.6 XVII-d 2.9VIIee 40.8 VIII-d 8.8 X-d 27.4 IX-m 11.3 XI-cc 5.5 XII-d 8.4Assay 2. Mucociliary Clearance (MCC) Studies in Sheep

The animal model that has been used most often to measure changes in MCCis the sheep model. The effect of compounds for enhancing mucociliaryclearance (MCC) can be measured using an in vivo model described bySabater et al., Journal of Applied Physiology, 1999, pp. 2191-2196,incorporated herein by reference.

In these studies, adult sheep were restrained and nasally intubated withan endotracheal tube. Aerosolized test articles were administered over10-15 minutes to sheep. Radiolabeled ^(99m)Tc-sulfur colloid (TSC, 3.1mg/mL; containing approximately 20 mCi) was then administered at aspecified time four or eight hours after test article. The radiolabeledaerosol was administered through the endotracheal tube for about 5minutes. The sheep were then extubated, and total radioactive counts inthe lung were measured every 5 minutes for a 1-hour observation period.The rate of radiolabel clearance from the lung is representative of theMCC rate in the animal. The advantage of this system is that it closelysimulates the human lung environment. The model also allows for thecollection of simultaneous PK/PD information through plasma and urinesampling over the test period. There are also several techniques tomeasure the drug concentrations on the airway surface during the MCCmeasurements. These include the collection of exhaled breath condensatesor a filter paper method to obtain ASL via bronchoscopy.

The ovine model described above was used to evaluate the in vivo effects(efficacy/durability) of aerosol-delivered Compound II-d on MCC.Treatments consisting of either 4 mL of Compound II-d, ComparativeExample 1,(S)-3,5-diamino-6-chloro-N—(N-(4-(4-(2,3-diamino-3-oxopropoxy)phenyl)butyl)carbamimidoyl)pyrazine-2-carboxamide,vehicle (sterile distilled H₂O), or test agent in combination with HSwere tested. To determine if combining HS with Compound II-d MCC, HS wasadministered immediately following Compound II-d administration. Testsolutions were aerosolized using a Raindrop nebulizer at a flowrate ofeight liters per minute and connected to a dosimetry system consistingof a solenoid valve and a source of compressed air (20 psi). Thedeposited dose of drug in sheep lungs after an aerosol administrationusing the Raindrop nebulizer is estimated to be 8-15% of the dose. Usinga Raindrop nebulizer, radiolabeled TSC was administered overapproximately 3 minutes either 4 or 8 hours after drug treatment toevaluate efficacy/durability. Radioactive counts were measured in acentral region in the right lung at 5 min intervals for one hour with agamma camera. Three methods of analysis were utilized, 1) initial rateof clearance (slope) over the first 30 min fitted using linearregression 2) area under the curve for % clearance over time over onehour, and 3) the maximum clearance obtained in one hour.

The effect of Compound II-d at 0.024 nmol/kg, 0.24 nmol/kg and 2.4nmol/kg were tested and compared to vehicle (4 mL sterile H₂O) on sheepMCC four hour post-dosing (FIG. 1). The analyses of effects are shown inTable 2. At all doses tested, Compound II-d enhanced MCC compared tovehicle control. The 0.24 nmol/kg dose was considered to be a maximum(100%) MCC effect at the top of the dose response curve as illustratedin FIG. 2. The ED₅₀ dose for Compound II-d was approximately 0.024nmo/kg. Importantly, doses as high as 24 nmol/kg (1,000 times the ED₅₀)exhibited no increase in plasma potassium (a marker for hyperkalemia) asseen in FIG. 2.

TABLE 2 MCC in Sheep at 4 h Post-dose of Compound (Ia) or VehicleCompound Initial Slope AUC Maximum II-d Dose (4.0-4.5 h) (% Cl-h)Clearance 0.24 nmol/kg (3 μM) 41.9 ± 3.7* (4) 19.8 ± 1.4* (4) 34.4 ±2.9* (4) 0.024 nmol/kg (300 nM) 26.5 ± 1.4* (4) 11.5 ± 0.9* (4) 20.5 ±1.0* (4) Vehicle (H₂O) 4 mL 17.2 ± 6.8 (8)  7.3 ± 1.5 (8) 12.2 ± 2.9 (8)Data are reported as the mean ± SD (n) *Indicates significance (p <0.05) from vehicle.

FIG. 3 demonstrates that the potent, in vivo effect on sheep MCC carriesover to the napthyl series of compounds as well.

Assay 3. Airway Surface Liquid Drug (ASL) Clearance and Metabolism byHuman Airway Epithelium

The disappearance of Compound II-d from the apical surface and airwayepithelial metabolism were assessed in human bronchial epithelial (HBE)cells (Table 3). In these experiments 25 μL of a 25 μM solution of ENaCblocker was added to the apical surface of HBE cells grown at anair/liquid interface, and the drug concentration in the apical andbasolateral compartment was measured over 2 h by UPLC. After 2 hincubation of Compound II-d on the apical surface (37° C.), nometabolites were detected on either the apical or basolateral sides andno Compound II-d was detectable on the basolateral side.

TABLE 3 Apical Disappearance and Metabolism of Compound II-d and RelatedCompounds vs. Comparative Example 1 in HBE % of Initial % of % ofInitial % on Drug Mass Apical Apical Basolateral on Apical Mass as Masson Side as Side (Parent and Metabolites Basolateral Metabolites Compoundmetabolite, 2 h) (2 h) Side (2 h) (2 h) II-d 88.0 ± 021% None 1.6 ±0.15% None Values represent the mean ± SDAssay 4. Airway Hydration and Sodium Channel Block (In Vitro Model)

Parion Sciences has developed experimental models for assessing airwayhydration in cell cultures (Hirsh, A. J., Sabater, J. R., Zamurs, A.,et. al. Evaluation of second generation amiloride analogs as therapy forCF lung disease. J. Pharmacol. Exp. Ther. 2004; 311(3): 929-38. Hirsh,A. J., Zhang, J., Zamurs, A., et al. Pharmacological properties ofN-(3,5-diamino-6-chloropyrazine-2-carbonyl)-N′-4-[4-(2,3-dihydroxypropoxy)phenyl]butyl-guanidine methanesulfonate (552-02), a novelepithelial sodium channel blocker with potential clinical efficacy forCF lung disease. J. Pharmacol. Exp. Ther. 2008; 325(1): 77-88).

Primary CBE cells are plated onto collagen-coated, porous membranesmaintained at an air-liquid interface to assess maintenance of surfaceliquid volume over time. At the start of the experiment, each 12 mmsnapwell insert was removed from the plate containing air-liquidinterface culture media, blotted dry, weighed, and 50 μL of vehicle(0.1% DMSO), or ENaC blocker (10 μM in 0.1% DMSO) applied to the apicalsurface and the mass was recorded. The inserts were immediately returnedto a transwell plate (500 μL, Krebs Ringer Bicarbonate (KRB), pH 7.4 inlower chamber) and placed in a 37° C., 5% CO₂ incubator. To reduceartifact due to an apical carbohydrate osmotic gradient upon water loss,glucose was not included in the apical buffer. Compound (1a) was testedand compared to vehicle, and the mass of ASL was monitored serially from0-8 or 24 h. The mass of surface liquid was converted to volume in μL.Data are reported as % initial volume (100%=50 μL).

The duration of sodium transport inhibition was determined indirectly bymeasuring the buffer retained after a 50 μl volume of experimentalbuffer was added to the apical surface of CBE cells. Only 12.5±12.1% ofvehicle (buffer) remained on the surface after 8 hours and a smallincrease in surface liquid retention was seen with 10 μM amiloride inthe vehicle (25±19.2% after 8 hours). In comparison, Compound II-dsignificantly increased apical surface liquid retention, maintaining112±11% (n=6) of the surface liquid over 8 hours.

To test Compound II-d further, the duration of incubation was increasedfrom eight to 24 hours. Amiloride was not tested over 24 hours as themajority of the effect was gone after eight hours. After 24 hours, only11% of the vehicle buffer remained whereas, Compound II-d maintained70.6±8.0% (n=42) of surface liquid over 24 hours, a loss of only 16%relative to the 8-hour measure, suggesting Compound II-d exhibits adurable effect on liquid retention.

COMPARATIVE EXAMPLES

The present compounds of Formula (A) are more potent and/or absorbedless rapidly from mucosal surfaces, especially airway surfaces, comparedto known sodium channel blockers, such as amiloride and third generationcompounds such as Comparative Example 1 described below. Therefore, thecompounds of Formula (A) have a longer half-life on mucosal surfacescompared to these know compounds as evidenced by the data shown in Table4. The disappearance of Compound II-d from the apical surface and airwayepithelial metabolism were assessed in HBE and compared to ComparativeExample 1 (Table 4). In these experiments 25 μL of a 25 μM solution ofENaC blocker was added to the apical surface of HBE cells grown at anair/liquid interface, and the drug concentration in the apical andbasolateral compartment was measured over 2 h by UPLC. After 2 hincubation of the compounds of this present invention on the apicalsurface (37° C.), no metabolites were detected on either the apical orbasolateral sides and only small amounts of these compounds weredetectable on the basolateral side. In contrast, most of ComparativeExample 1 was eliminated from the apical side with 83% metabolized tothe less active carboxylic acid,(S)-2-amino-3-(4-(4-(3-(3,5-diamino-6-chloropyrazine-2-carbonyl)guanidino)butyl)phenoxy)propanoic acid, structure below.

TABLE 4 Apical Disappearance and Metabolism of Compound II-d and RelatedCompounds vs. Comparative Example 1 in HBE % of Initial % of % ofInitial % on Drug Mass on Apical Apical Basolateral Apical Side Mass onMass on Side as (Parent and Metabolites Basolateral Metabolites Compoundmetabolite, 2 h) (2 h) Side (2 h) (2 h) II-d 88.0 ± 21% None  1.6 ±0.15% None Comparative 41.6 ± 7.6% 83.0 ± 03.5%  8.3 ± 0.2 94.7 ± 1.0%Example 1 (8% Parent) (1% Parent) III-d 53.8 ± 5.9% none  3.5 ± 2.2%None V-d 25.6 ± 5.1% none  9.3 ± 0.86% None VI-d 67.3 ± 25.6% None  1.2± 0.5% None XIII-bb 72.6 ± 2.9% None  4.2 ± 1.9% None XIV-d 62.2 ± 14.9%None 0.32 ± 0.6% None XV-dd 39.4 ± 6.7% None 1.81 ± 1.6% None XVI-ee77.7 ± 12.2% None 14.9 ± 1.4% None XVII-d 76.6 ± 14.7% None  1.9 ± 1.7%None VII-ee 66.8 ± 14.1% None  6.4 ± 2.1% None VIII-d 62.7 ± 4.7% None 2.0 ± 0.8% None X-d 66.9 ± 22.9% None  5.0 ± 3.3% None IX-m 61.3 ± 7.7%None  1.1 ± 0.2% None XI-cc 55.6 ± 17.7% None  1.8 ± 0.3% None XII-d31.4 ± 17.4% None  9.6 ± 6.3% None Values represent the mean ± SD

Comparative Example 1,(S)-3,5-diamino-6-chloro-N—(N-(4-(4-(2,3-diamino-3-oxopropoxy)phenyl)butyl)carbamimidoyl)pyrazine-2-carboxamide,having the structure:

is claimed, described or within the disclosures of WO 2003/070182 (U.S.Pat. Nos. 6,858,615; 7,186,833; 7,189,719; 7,192,960; and 7,332,496), assodium channel blockers having useful medicinal properties and can beprepared by methods described therein and others known in the art.

The compound of Comparative Example 1 can be seen on page 15 of US2005/0080093 and as Compound 2 on page 90 of WO 2008/031048, and asCompound 2 on pages 42-43 of WO 2008/031028. In order to have usefulactivity in treating Cystic Fibrosis and C.O.P.D a compound must haveproperties that will cause enhancement of mucociliary clearance (MCC) atdoses that do not elevate plasma potassium which will eventually lead tohyperkalemia, a serious and dangerous condition, upon multiple dosing.It must therefore be avoided in this class of compounds, which are knownto elevate plasma potassium if they are significantly excreted by thekidney. In order to evaluate this potential, it is beneficial to haveMCC activity in vivo and not cause elevation of plasma potassium at theuseful dose. One model to assess this is the sheep MCC model describedbelow.

As can be seen from the Table 5 and FIG. 4 the ED₅₀ for ComparativeExample 1 in the sheep MCC model is approximately 240 nmol/kg (3 mM)using three different measures (slope, AUC and Maximum Clearance). Atthis dose, which would be a clinically active dose, Comparative Example1 causes a rise in plasma potassium (FIG. 5) which on repeat dosing willlead to hyperkalemia. Thus, Comparative Example I is unacceptable forhuman use while Compound II-d produces a safe and effective MCC with abenefit to risk ratio greater than 1000 in this model.

TABLE 5 MCC in Sheep at 4 h Post-dose of vehicle, Comparative Example 1or Compound II-d Initial Slope AUC Maximum Dose (4.0-4.5 h) (% Cl × h)Clearance Comparative Example 1 32.2 ± 7.3* 14.1 ± 2.2* (6) 22.9 ± 2.1*(6) 240 nmol/kg (3 mM) (6) Comparative Example 1 14.5 ± 1.3 (3)  6.9 ±1.0 (3) 14.6 ± 0.9 (3) 24 nmol/kg (300 μM) Compound II-d 26.5 ± 1.4*11.5 ± 0.9* (4) 20.5 ± 1.0* (4) 0.024 nmol/kg (300 nM) (4) Vehicle H₂O(4 mL) 17.2 ± 6.8 (8)  7.3 ± 1.5 (8) 12.2 ± 2.9 (8)

FIG. 6 graphs the percentage mucus clearance over time by Compound II-dand Comparative Example 1, as described in the MCC model, above. Asimilar percentage mucus clearance was provided by Compound II-d at a10,000-fold lower dose than seen with Comparative Example 1. CompoundII-d provided a maximal effect in a clinically relevant dose range.

FIG. 7 illustrates the significant increase in plasma potassium levelsat an efficacious dose seen in the plasma of the sheep receivingComparative Example 1 in the MCC study. Compound II-d is 10,000 timesmore potent in sheep MCC than Comparative Example 1 with no elevation ofPlasma K at doses as high as 24 nmol/kg (1000 times the ED50 dose),whereas Comparative Example 1 has elevations of plasma K at theapproximate ED50 dose of 3 mM (FIGS. 6 and 7). This, again, demonstratesthe unique and unexpected potency and safety advantage of Compound II-das seen in Table 6 with a Therapeutic Index of 10,000-100,000 timesgreater renal safety than Comparative Example 1.

TABLE 6 Therapeutic Ratio (Benefit/Risk) Top Dose in MCC Sheep with noHighest Elevation of Submaximal Plasma Therapeutic Compound DosePotassium Ratio Comparative Example 1 3 mM 300 μM 0.1 II-d 300 nM 300 μM1,000 Ratio 10,000 1 10,000

That which is claimed is:
 1. A compound of Formula (A):

wherein: Ar is a moiety selected from the group consisting of:

X is selected from the group consisting of —CH₂—, —O—, and —S—; R¹ andR² are independently selected from the group consisting of H and C₁-C₆alkyl, or R¹ and R² together with the nitrogen atom to which they arebound form a 5-membered or 6-membered heterocyclic ring optionallycontaining one additional ring heteroatom selected from N and O; R³ isan alkyl group having from 3 to 8 carbon atoms or a polyhydroxylatedalkyl group having from 3 to 8 carbon atoms; R⁴ is a polyhydroxylatedalkyl group having from 3 to 8 carbon atoms; and R⁵ is H or C₁-C₃ alkyl;or a pharmaceutically acceptable salt thereof.
 2. The compound of claim1, which is represented by any one of Formulae (B)-(G):

wherein: R¹ and R² are independently H or C₁-C₆ alkyl, or R¹ and R²together with the nitrogen atom to which they are bound form a5-membered or 6-membered heterocyclic ring optionally containing oneadditional ring heteroatom selected from N and O; R³ is an alkyl grouphaving from 3 to 8 carbon atoms or a polyhydroxylated alkyl group havingfrom 3 to 8 carbon atoms; R⁴ is a polyhydroxylated alkyl group havingfrom 3 to 8 carbon atoms; and R⁵ is H or C₁-C₃ alkyl; or apharmaceutically acceptable salt thereof.
 3. The compound of claim 1,wherein R³ is a polyhydroxylated alkyl group represented by the formula—CH₂—(CHR⁵)_(n), wherein n is an integer selected from 2, 3, 4, 5, 6,and 7; and R⁵ is independently in each instance H or OH, with theproviso that at least two of the R⁵ groups are OH, or a pharmaceuticallyacceptable salt thereof.
 4. The compound of claim 1, wherein thepolyhydroxylated alkyl group is represented by the formula—CH₂—CHOH—(CHR⁶)_(m), wherein m is an integer selected from 1, 2, 3, 4,5, and 6; and R⁶ is independently in each instance H or OH, with theproviso that at least one of the R⁶ groups is OH, or a pharmaceuticallyacceptable salt thereof.
 5. The compound of claim 1, wherein thepolyhydroxylated alkyl group is represented by the formula—CH₂—(CHOH)_(n)—CH₂OH, wherein n is an integer selected from 1, 2, 3, 4,5, and 6; or a pharmaceutically acceptable salt thereof.
 6. The compoundof claim 1, wherein the polyhydroxylated alkyl group is represented bythe formula:

or a pharmaceutically acceptable salt thereof.
 7. The compound of claim1, wherein the polyhydroxylated alkyl group is represented by theformula:

or a pharmaceutically acceptable salt thereof.
 8. The compound of claim1, wherein the compound is selected from one of the following:

and pharmaceutically acceptable salts thereof.
 9. A pharmaceuticalcomposition comprising a pharmaceutically effective amount of a compoundof claim 1, or a pharmaceutically acceptable salt thereof, and apharmaceutically acceptable carrier or excipient.
 10. The composition ofclaim 9, wherein said composition is suitable for inhalation.
 11. Thecomposition of claim 10, which is a solution for aerosolization andadministration by nebulizer, metered dose inhaler, or dry powderinhaler.
 12. The pharmaceutical composition of claim 9, furthercomprising an osmolyte.
 13. The pharmaceutical composition of claim 12,wherein the osmolyte is hypertonic saline.
 14. A compound of one of thefollowing formulae:

or a pharmaceutically acceptable salt thereof.
 15. A pharmaceuticalcomposition comprising a pharmaceutically effective amount of a compoundof claim 14, or a pharmaceutically acceptable salt thereof, and apharmaceutically acceptable carrier or excipient.
 16. The pharmaceuticalcomposition of claim 15, further comprising an osmolyte.
 17. Thepharmaceutical composition of claim 16, wherein the osmolyte ishypertonic saline.
 18. The compound of claim 1, wherein the compound isrepresented by any one of Formulae (H)-(M):

wherein: R¹ and R² are independently H or C₁-C₆ alkyl, or R¹ and R²together with the nitrogen atom to which they are bound form a5-membered or 6-membered heterocyclic ring optionally containing oneadditional ring heteroatom selected from N and O; R³ is an alkyl grouphaving from 3 to 8 carbon atoms or a polyhydroxylated alkyl group havingfrom 3 to 8 carbon atoms; R⁴ is a polyhydroxylated alkyl group havingfrom 3 to 8 carbon atoms; and R⁵ is H or C₁-C₃ alkyl; or apharmaceutically acceptable salt thereof.
 19. A compound of one of thefollowing formulae:


20. A compound of one of the following formulae: